7 Attachment G_Leadership Academy Completion Survey

OMB No: 0915-0212

Expiration date: 04/30/2024

Leadership Academy (Completion) Survey

Sent at the completion of each Leadership Academy

Public Burden Statement: The purpose of this information collection request is to assess participant satisfaction with various training and TA activities offered through a contracted TA provider, the Education Development Center. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. This data collection is voluntary. The OMB control number for this project is 0915-0212 and is valid until 04/30/2024. Public reporting burden for this collection of information is estimated to average .08 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857.

1. Overall, how satisfied were you with the Leadership Academy?

   1. Extremely satisfied

   2. Satisfied

   3. Dissatisfied

   4. Extremely dissatisfied

2. [If chosen “Dissatisfied” or “Extremely dissatisfied”] Please explain why you were dissatisfied with the Leadership Academy: [Open text]

3. How relevant were each of the sessions to your work? [Matrix]

• Session 1: What is Leadership

• Session 2: How do I lead in different situations?

• Session 3: How do I manage changes within my program?

• Session 4: How do I engage with conflict?

• Session 5: How can leadership be shared?

• Session 6: How have I grown as a leader?

4. After participating in the Leadership Academy, how prepared are you to do each of the following? [Matrix]

1. Define leadership

2. Lead in different situations

3. Manage changes within my program

4. Engage with conflict

5. Share leadership

6. Identify new areas for growth in my leadership style

5. Have you taken any action steps as a result of your participation in the Leadership Academy?

   1. Yes

   2. No

6. [If yes] Please describe 1-2 action steps you have taken as a result of your participation in the Leadership Academy: [Open text]

7. [If no] Please provide any suggestions you may have for how the Leadership Academy could have better supported you in taking action: [Open text]

8. What was the MOST helpful feature of the Leadership Academy? [Open text]

9. What was the LEAST helpful feature of the Leadership Academy? [Open text]

10. Did you experience any barriers to participating in the Leadership Academy, such as difficulties participating fully in the virtual sessions, online discussion boards, or peer mentorship opportunities?

7. Yes

8. No

9. Maybe

11. [If yes or maybe] Please describe the barriers you experienced: [Open text]

12. We are particularly interested in whether this Leadership Academy was provided in a culturally appropriate manner. Please rate your agreement with the following statement: This Leadership Academy was provided in a culturally responsive manner (respectful of individual beliefs, language, perspectives, and needs).

10. Strongly agree

11. Agree

12. Neither agree nor disagree

13. Disagree

13. How can we improve future Leadership Academies? [Open text]

14. As we work to improve the Leadership Academies, would you be willing to speak with us if we wanted to follow up on some of the feedback that you provided (we would simply contact you via email)?

14. Yes, I would be willing to speak with you.

15. No, I would prefer not to.