6 Small Group TA Closeout Survey

OMB No: 0906-0084

Expiration date: 02/28/2027

Small Group TA Closeout Report Survey

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. The OMB control number for this project is 0906-0084 and is valid until 02/28/2027. This information collection is voluntary. Public reporting burden for this collection of information is estimated to average .12 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 Information Collection Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857 or [email protected].  

1. Overall, how satisfied are you with the small group technical assistance (TA) you received from TARC?

   1. Extremely satisfied

   2. Satisfied

   3. Dissatisfied

   4. Extremely dissatisfied

2. [If chosen “Dissatisfied” or “Extremely dissatisfied”] Please explain why you were dissatisfied with this small group TA request: [Open text]

3. Below are the objectives created during the TA request by you and your TA Specialist(s). Please indicate the extent to which you agree that these objectives were met: [Matrix]

   1. Objective [Objectives are identified at the beginning of a Level 2 or 3 TA occurrence by both the awardee and the TA Specialist. They are documented in the Closeout Report. The language here will be tailored to the individual objectives of that closeout report, but we do not expect to have more than 1-3 objectives per closeout report.]

   2. Objective [Objectives are identified at the beginning of a Level 2 or 3 TA occurrence by both the awardee and the TA Specialist. They are documented in the Closeout Report. The language here will be tailored to the individual objectives of that closeout report, but we do not expect to have more than 1-3 objectives per closeout report.]

4. Was this your first time participating in a TARC small group TA request?

1. Yes

2. No

3. Unsure

5. Think back to when you first learned you would be participating in this small group TA request. Were the expectations you had for what you wanted to get out of this small group TA request met?

   1. Yes

   2. No

6. [If no] Please explain: [Open text]

7. On a scale from 1-5, please rate how effective the small group TA request was at connecting you with peers from other states or territories who are addressing similar issues.

   1. 1 (Not effective)

   2. 2

   3. 3

   4. 4

   5. 5 (Very effective)

8. [If a or b] How could this small group TA request have better connected you with your peers?

9. Have you taken any action steps as a result of the TA received during this small group TA request?

   1. Yes

   2. No

10. [If yes] Please describe 1-2 action steps you have taken as a result of the TA request: [Open text]

11. [If no] Please describe how we could have better supported you in taking action steps [Open text]?

12. How can we improve future small group TA requests? [Open text]

13. Is there anything we haven’t asked you about your experiences with this small group TA request that you would like to share?

14. Please rate your agreement with the following statement: This small group TA request integrated diversity, equity, and inclusion into the content it provided.

    1. Strongly agree

    2. Agree

    3. Disagree

    4. Strongly disagree

15. To what extent did you see diversity, equity, and inclusion show up in the approach of the TA provided?

    1. To a great extent

    2. Somewhat

    3. Very little

    4. Not at all

16. Please comment with any suggestions for how we can improve our technical assistance to more intentionally integrate diversity, equity, and inclusion.

17. As we work to improve our TA, would you be willing to speak with us if we wanted to follow up on some of the feedback you provided (we would contact you via email)?

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

    2. No, I would prefer not to.

18. [If yes] Please provide your email [Open text]