Implementation Evaluation: Program Participant Web Survey
Introduction
The purpose of this survey is to learn more about the citizenship program that [THIS ORGANIZATION] provided as part of a study we are conducting. We will ask you questions about your experiences with the English and civics instruction, and naturalization application services provided by [THIS ORGANIZATION]. We would appreciate your honest responses to these questions. Your participation is voluntary, and your responses will have no impact on any pending immigration requests you or your family may have submitted. USCIS and Optimal Solutions Group, LLC will maintain the confidentiality of your responses, as applicable by law. No individual or organization responses will be identified in the final report.
The Office of Management and Budget Control authorized this survey under OMB Survey control number 1615-NEW, which expires [MM-DD-YYYY]. For more details on OMB authorization, please visit the following website.
DHS Privacy Notice
AUTHORITIES: USCIS is collecting the information requested on this survey, and the associated evidence, under the Immigration and Nationality Act (INA) sections 8 U.S.C. § 1443(h) (section 332(h)), Section 538 of the Department of Homeland Security Appropriations Act, 2016 (Pub. L. No. 114-113), Foundations for Evidence-Based Policymaking Act of 2018 (‘Evidence Act’), (Pub. L. No. 115-435, 132 Stat.5529), Program Management Improvement Accountability Act of 2016 (PMIAA), (Pub. L. No. 114-264, 130 Stat. 1371), Government Performance and Results Act of 1993 (GPRA), (Pub. L. No. 103-62, 107 Stat. 285), and Government Performance and Results Act Modernization Act of 2010 (GPRAMA), (Pub. L. No. 111-352, 124 Stat. 3866).
PURPOSE: The primary purpose for providing the requested information on this survey is to assess the degree to which USCIS programs are meeting their overall goal of integrating immigrants and refugees into American society. The study encompasses data collection of program participants (refugees and lawful permanent residents who enrolled in a program offered by one of the grantees between FY 2018 and FY 2021).
ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, share the information you provide on this survey and any additional requested evidence with other Federal, state, local, and foreign government agencies and authorized organizations. DHS follows approved routine uses described in the associated published system of records notices [DHS/ALL-002 DHS Mailing and Other Lists System and DHS/USCIS/ICE/CBP-001 - Alien File, Index, and National File Tracking System] and the published privacy impact assessments [DHS/USCIS/PIA-056 USCIS Electronic Immigration System, DHS/USCIS/PIA-066 Citizenship and Integration Grant Program, DHS/ALL/PIA-069 DHS Surveys, Interviews, and Focus Groups, and DHS/USCIS/PIA-089 USCIS Outreach and Engagement Program ] which you can find at www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement purposes or in the interest of national security.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and any requested evidence, may prevent USCIS from determining whether its programs are effective in integrating immigrants and refugees into American society.
Paperwork Reduction Act Statement
An agency may not conduct or sponsor an information collection and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The public reporting burden for this collection of information is estimated at 30 minutes per response, including the time for reviewing instructions, completing, and submitting the form. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to U.S. Citizenship and Immigration Services, Office of the Chief Financial Officer, Evaluation Branch, 5900 Capital Gateway Drive, Mail Stop # 2130, Camp Springs, MD 20588-0009. OMB No. 1615-NEW. Do not return the completed form to this address.
Program Outreach
When did you first hear of the citizenship program offered by [THIS ORGANIZATION]? MM/YYYY
How and where did you hear of the citizenship program offered by [THIS ORGANIZATION]? Select all that apply.
Outreach Activities |
Heard about program |
Informational sessions conducted by [THIS ORGANIZATION] |
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Other in-person events or meetings in the community |
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Virtual events |
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Word of mouth (via friends, family, etc.) |
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Websites (including blogs, forums) |
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Emails (including e-newsletters) |
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Print media (including flyers, posters, newspapers, magazines, or newsletters) |
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Phone (including calls, text messages) |
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Social media (including apps) |
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Radio |
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TV |
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Multilingual outreach activities |
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Other activities, please specify ____________ |
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Locations |
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Schools (including public/private school, community college, university) |
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Library |
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Community-based organizations |
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Faith-based places of worship |
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Local businesses |
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Social service agencies |
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Health, medical centers, or clinics |
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Other locations, please specify _____________ |
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Did you learn about the citizenship program offered by [THIS ORGANIZATION] in:
English
A language other than English
Both
How satisfied are you with the citizenship program offered by [THIS ORGANIZATION]?
Very much
Somewhat
Not at all
Not applicable
In the future, how do you think people like yourself would like to learn about programs that help immigrants to adjust in the U.S.? Select all that apply.
Future Interest |
|
Informational sessions conducted by [THIS ORGANIZATION] |
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Other in-person events or meetings in the community |
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Virtual events |
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Engage former participants and community leaders |
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Websites (including blogs, forums) |
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Emails (including e-newsletters) |
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Print (including flyers, posters, newspapers, magazines, or newsletters) |
|
Phone (including calls, text messages) |
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Social media (including apps) |
|
Radio |
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TV |
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Multilingual outreach activities |
|
Other activities, please specify____________________________ |
|
In the future, how do you think people like yourself would like to learn about other programs that help immigrants to adjust in the U.S. in:
English
A language other than English
Both
When you were considering applying to this program, what were the most important factors in deciding whether to follow through? Choose the three most important factors.
Most Important Factors |
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Reputation of the program |
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Other people told me good things about the program |
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Distance from my home/work |
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After hours scheduling including nights/weekends |
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Childcare options |
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Public transportation options |
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Services available virtually |
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Accommodation for people with disabilities |
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Likelihood that I would obtain citizenship |
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Other factors, please specify |
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Program Details
What additional citizenship class activities and resources did you find helpful when learning about civics-related English, civics, and the naturalization process? Select all that apply.
Activities and Resources |
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Interview practice/mock interviews |
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Vocabulary flash cards or vocabulary practice |
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Small group activities |
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Real life materials (including news articles, brochures, menus, etc.) to practice listening and speaking |
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Computer based activities for practice or extra assistance |
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Lesson handouts |
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Other activities and resources, please specify _________________________ |
|
What other activities were available if you missed class, needed help, or wanted extra practice? Select all that apply.
Activities |
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Individual tutoring |
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Small group tutoring |
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Computer based activities or online resources |
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Additional English or ESL classes |
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Study groups |
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Test preparation |
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Interview practice |
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Classroom assistance during class |
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Other activities, please specify _______________________ |
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Did you experience any of the following problems during the program? Select all that apply.
Problems |
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Difficult program application process |
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Difficult or time-consuming intake process |
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Inconvenient class schedule |
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Challenging class material/content |
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Language issues |
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Transportation problems |
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Childcare issues |
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Cost of class or class materials (including textbook) |
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Limited availability of online services or activities |
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Limited referrals to other needed services or programs |
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Other problems, please specify ______________________ |
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Please rate your overall satisfaction with your instructor(s) for English language, civics-based literacy, and citizenship instruction classes in the following areas:
|
Not at all satisfied |
Somewhat Satisfied |
Very Satisfied |
Not applicable |
Knowledge of class material |
|
|
|
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Engaged the class |
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|
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Used visual aids and materials to instruct the class |
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|
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Communicated clearly and effectively |
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Used real life and participants’ ideas in the course material |
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Engagement Information
To what extent do you:
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Not at all |
Somewhat |
Very much |
Consider yourself as an American |
|
|
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Feel that you belong in the U.S. |
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|
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How often do you:
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Never |
Sometimes |
Often |
Speak English |
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Read in English |
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|
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Write in English |
|
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Celebrate U.S. holidays (e.g., 4th of July, Thanksgiving) |
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Watch U.S. media (TV, movies, websites, music) |
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Use social media to interact with Americans |
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Interact with American friends, coworkers, or acquaintances |
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Interact with American neighbors and community residents |
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Participate, volunteer, or donate to U.S. organizations |
|
|
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To what extent do you consider yourself as belonging to your culture of origin:
Not at all
Somewhat
Very much
Not applicable
How often do you:
|
Never |
Sometimes |
Often |
Use your native language |
|
|
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Celebrate your culture of origin’s holidays |
|
|
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Use your native language media (TV, movies, websites, music) |
|
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Use social media to interact with people from your culture of origin |
|
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Interact with people from your culture of origin |
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Interact with neighbors and community residents from your culture of origin |
|
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Participate, volunteer, or donate to local immigrant organizations |
|
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Program Engagement
Please estimate when you first decided to become an American citizen. MM/YYYY
Which activities provided by [THIS ORGANIZATION] did you participate in? Select all that apply.
English (ESL) language class
Civics-based literacy class
Citizenship instruction
Naturalization application services (application form, assistance with fees, access to legal aid)
Referrals to other services
Other activities, please specify
Please estimate how many total hours of activities provided by [THIS ORGANIZATION] you participated in (including civics class, additional ESL classes, tutoring, practice interviews, naturalization services, etc.).
What recommendations do you have to improve the citizenship program at [THIS ORGANIZATION]?
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Pitts, Wayne |
| File Modified | 0000-00-00 |
| File Created | 2025-04-18 |