The Work Plan request participant feedback form

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WEBINAR

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback

In order to help OVC TTAC better serve the field, we would like to obtain your feedback. We will protect the privacy of your
information in accordance with the Federal Privacy Act, and we will protect the confidentiality of your responses using
procedures we have in place. Answers to these questions will be reported after aggregating all responses. Your participation in
this survey is completely voluntary. If you have any questions about this survey or the evaluation, please contact
[email protected].
EVENT/ASSISTANCE:

SESSION:

LOCATION:

DATE(S):

PRESENTER(S):
LEARNING OBJECTIVES:

Email: _________________________
Please rate your satisfaction with the following sessions.

SESSIONS
1.
2.
3.
4.
5.
6.
7.
8.

[Session name]
[Session name]
[Session name]
[Session name]
[Session name]
[Session name]
[Session name]
[Session name]

Very
Dissatisfied

Dissatisfied

Neither
Dissatisfied
nor
Satisfied

Satisfied

Very
Satisfied

Not
Applicable

1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4

5
5
5
5
5
5
5
5

NA
NA
NA
NA
NA
NA
NA
NA

Strongly
Disagree

Disagree

Neither
Agree nor
Disagree

Agree

Strongly
Agree

Not
Applicable

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

Strongly
Disagree

Disagree

Neither
Agree nor
Disagree

Agree

Strongly
Agree

Not
Applicable

1

2

3

4

5

NA

1
1

2
2

3
3

4
4

5
5

NA
NA

1

2

3

4

5

NA

1
1

2
2

3
3

4
4

5
5

NA
NA

Please indicate the extent to which you agree or disagree with the following statements.

PRESENTER/FACILITATOR 1: ___________________
9.

The presenter demonstrated a comprehensive knowledge of the
subject./The facilitator helped the meeting to stay on track with the
scheduled agenda.
10. The presenter clearly and logically presented the content./The
facilitator managed the discussion well, allowing and encouraging
multiple people to share feedback.
11. The presenter/facilitator responded well to questions and
comments.
12. The presenter/facilitator created a respectful environment for
participants.

OVERALL SESSION
13. The session/assistance clearly addressed the learning
objectives/stated objectives. (See above for learning objectives.)
14. As a result of this assistance, I can…
15. As a result of this assistance, I can…
16. The session/assistance addressed the critical issues related to the
topic(s).
17. The time allotted was adequate for the scope of material covered.
18. The session/assistance was well organized and clear.

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 10 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the OVC TTAC evaluation team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

WEBINAR

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback

19. The content was appropriate for my level of experience and
1
2
3
4
5
NA
knowledge.
20. The resource materials (handouts, audiovisuals, PowerPoints)
1
2
3
4
5
NA
enhanced the session.
21. The session/assistance increased my knowledge related to the
1
2
3
4
5
NA
topic(s).
22. The session/assistance increased my practical skills related to the
1
2
3
4
5
NA
topic(s).
23. I will be able to apply what I learned in my work.
1
2
3
4
5
NA
24. The session/assistance improved my ability to serve victims.
1
2
3
4
5
NA
25. The session/assistance improved my ability to reach underserved
1
2
3
4
5
NA
victims.
26. The session/assistance improved my ability to collaborate with
1
2
3
4
5
NA
others.
27. The session/assistance provided sufficient opportunity to network
1
2
3
4
5
NA
with others in the field.
28. The [small group activity/discussion] enhanced my experience.
1
2
3
4
5
NA
29. The session/assistance met my professional needs.
1
2
3
4
5
NA
30. I am satisfied with the overall quality of the session/assistance.
1
2
3
4
5
NA
Following the training, what three steps will you take to better serve victims of crime?
a. ___________________________________________________________________________________
b. ___________________________________________________________________________________
c. __________________________________________________________________________________
As a result of participating in this session, please rate your level of confidence in your likelihood to do any of the following:

31. Share material with colleagues
32. Refer colleagues to other OVC TTAC events/resources
33. Train/educate others in content/skills learned
34. Pursue additional professional development
35. Develop/strengthen use of technology or infrastructure
36. Develop/strengthen collaborative or strategic relationships
37. Expand services to new victim populations
38. Expand types of services offered to victims
39. Strengthen administrative capacity to better serve victims of crime
(e.g., financial management, develop a board of directors)
40. Enact policy changes at my organization
41. Begin a new project or initiative
42. Change my management, leadership, or interpersonal
communication style
43. Strengthen evaluation or needs assessment activities
44. Network with other participants
45. Identify/pursue new funding resources
46. Implement/change financial procedures
47. Modify outreach/marketing activities
48. Develop/enhance vision, mission, or strategic plan

Very Low

Low

Moderate

High

Very
High

Not
Applicable

1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4

5
5
5
5
5
5
5
5

NA
NA
NA
NA
NA
NA
NA
NA

1

2

3

4

5

NA

1
1

2
2

3
3

4
4

5
5

NA
NA

1

2

3

4

5

NA

1
1
1
1
1
1

2
2
2
2
2
2

3
3
3
3
3
3

4
4
4
4
4
4

5
5
5
5
5
5

NA
NA
NA
NA
NA
NA

Please specify any other actions you plan to take as a result of this session that are not listed in the table above.

____________________________________________________________________________________

WORK PLAN TA

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback

49. Please explain in detail any ways this session improved your organization’s capacity to better serve victims of crime:

___________________________________________________________________________________
___________________________________________________________________________________
□ Yes

50. Would you recommend OVC TTAC to others?

□ No

51. What aspects of the session were most helpful and why?

____________________________________________________________________________________
____________________________________________________________________________________
52. What could be done differently to improve the session?

____________________________________________________________________________________
____________________________________________________________________________________
53. Do you have any other comments or suggestions?

____________________________________________________________________________________
____________________________________________________________________________________
54. Following this session, what additional resource or trainings could OVC TTAC provide to support you and your organization?

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
55. How often have you engaged with OVC TTAC in the last 12 months? (Mark one.)
□ 1–3 times
□ 4–6 times

□ 7–9 times
□ 10+ times

56. Which of the following best describes your gender identity? (Mark one.)
□ Male
□ Female
□ Transgender Male

□ Transgender Female
□ Genderqueer/NonConforming/
Non-Binary

□ Two-Spirit
□ Not Listed (option to specify):
_________________________

57. Which of the following best describes your race/ethnicity? (Mark all that apply.)
□ American Indian or Alaska Native
□ Asian
□ Black/African American
□ Hispanic/Latino

□ Native Hawaiian or
Pacific Islander
□ White Non-Latino or
Caucasian

□ Not Listed (option to specify):
_________________________

58. Which of the following best describes the organization in which you work? (Mark all that apply.)
□ Community-Based/Grassroots
□ Health/Mental Health Services
□ Military
□ Criminal Justice Agency
□ Human/Social Services
□ Research
□ Education
□ Legal Services
□ Other (please specify):
□ Faith-Based
□ Legislation/Policymaking
_________________________
59. Which types of victim services do you provide for crime victims in your current position? (Mark all that apply.)
□ I do not provide direct services
□ Child Care
□ Compensation/Restitution
□ Counseling
□ Crisis Intervention

□ Criminal Justice System
Advocacy/Assistance
□ Housing/Shelter
□ Information/Referral
□ Medical/SANE/SART

□ Notification
□ Transportation
□ 24-Hour Hotline
□ Other (please specify):
_________________________

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the OVC TTAC evaluation team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

WORK PLAN TA

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback

60. Which of the following best describes the number of years of experience you have in your current field of work? (Mark one.)
□ Less than 3 years

□ 3 to 5 years

□ 6 to 10 years

□ More than 10 years

61. Which of the following best describes your primary role in your current position? (Mark all that apply.)
□ Direct Delivery/Front Line Staff
□ Management/Administrative Staff

□ Consultant/Trainer
□ Volunteer

□ Other (please specify):
_________________________

62. Which of the following best describes the population you serve? (Mark all that apply.)
□ National
□ State
□ Tribal
□ International, list country:
_________________________________

□ Local
□ Urban
□ Rural
□ Suburban

63. Please provide your city and state (i.e., location of organization or professional address).

___________________________________________________________________________________
64. Please list any marginalized or underserved populations you serve.

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

Thank you for taking the time to complete this form and helping to improve OVC TTAC activities.