DSCA Regional Center AM&E Program Survey

DSCA Regional Center AM&E Program Survey

Question 1:
Dear valued member of the [REGIONAL CENTER] community,
The [REGIONAL CENTER] is randomly surveying a select number of alumni in order to better understand
the impact of [REGIONAL CENTER] programs. We ask that you complete this simple survey (it will take
approximately 3 minutes to complete). Participation is voluntary, and responses will be kept
confidential.
Confidentiality and Consent. The technology being used to collect the survey information is Qualtrics
XM, a web-based platform. The Qualtrics system is authorized by the U.S. Federal Risk and Authorization
Management Program (FedRAMP) as a system appropriate for the handling and storage of Personally
Identifiable Information (PII) and is also GDRP (General Data Protection Regulation) compliant.
You have the option to not respond to any questions that you choose. Participation or nonparticipation
will not impact your relationship with the [REGIONAL CENTER]. Submission of the survey will be
interpreted as your informed consent to participate.
If you have any issues or concerns about the survey, please email the [REGIONAL CENTER] at [Regional
Center Point of Contact].
Required
I have read the above information and agree to participate in this research project
I do not wish to participate in this survey

OMB CONTROL NUMBER: XXXX-XXXX
OMB EXPIRATION DATE: XX/XX/XXXX
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, [Insert OMB Control Number], is estimated to
average 5 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding the burden estimate or burden reduction suggestions to the Department of Defense,
Washington Headquarters Services, at [email protected].
Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any
penalty for failing to comply with a collection of information if it does not display a currently valid OMB control
number.

Question 2:
In the past year, have you applied lessons or knowledge within your profession that was directly related
to your interactions and experiences with the [REGIONAL CENTER]?
Yes
No

Question 3:
Please describe how you have applied the lessons or knowledge gained from your interactions and
experiences with the [REGIONAL CENTER], and tell us how it influenced the security dynamics of your
country or region.
Examples may include:
•

Influencing strategy development or implementation

•

Influencing sectoral policy development or implementation

•

Influencing budget allocations

•

Designing a project or program

•

Information conversations with colleagues, including sharing tools and techniques from
[REGIONAL CENTER] programs

•

Developing or delivering talks or training

•

Convening alumni events on an issue covered in an [REGIONAL CENTER] program •
Developing or implementing new legislation

[Free response text box]

Survey end