SV-2007-0017 Study of the United States Institute 2006, Students (Fol

Hello! It has been some time since your exchange experience. We would like to ask you some questions about the program and its impact on your life since your return home. The information you provide will help us design programs that better meet the needs of our participants. Please know that your answers will be strictly confidential and will in no way affect your participation in the program. We will use the data for analytical and evaluative purposes only.

Please feel free to give us your honest opinions. This survey is not a test, and there are no right or wrong answers. Thank you for your participation in this survey.

Privacy Act and Paperwork Reduction Act Statements:

The information solicited on this survey is requested pursuant to the Government Performance and Results Act of 1993 (P.L. 103-62) and the Mutual Educational and Cultural Exchange Act of 1961, as amended, also known as the Fulbright-Hays Act (22 U.S.C. 2451, et seq.). In order to ensure that the U.S. Department of State’s international exchange programs meet statutory program requirements (22 U.S.C. 2460(c)), the Department’s Bureau of Educational and Cultural Affairs (ECA) regularly monitors the programs, gathers data about program accomplishments, and evaluates selected ones. ECA uses the information collected to inform program design, management, and funding. All personal information that is collected through surveys is considered confidential. All responses are coded to ensure the confidentiality of individual responses. Data collected under this study will not be shared, sold, or used for fundraising purposes. Survey data and findings will be used only in an aggregate form for the express purposes of fulfilling the data needs of the outcome assessment. Responses to this survey are voluntary.

Public reporting burden for this collection of information is estimated to average thirty (30) minutes to respond to this survey, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An Agency may not conduct or sponsor, and respondents are not required to respond to, a collection of information unless it displays a valid OMB control number. Please send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to: A/RPS/DIR, U.S. Department of State, Washington, D.C. 20520.

1. Exchange programs provide participants with many important opportunities for learning and engaging people from other countries. In the table below, please select the 3 accomplishments that have had the most impact on your life, since your return home.

Achievements	
Increased my understanding of American values, society and culture
Developed my leadership skills
Shared my experiences and learned more about community service and civic involvement
Made friends with American students
Made friends with other students in the program
Shared my culture with others
Improved my English
Other? (Write in)

2. Please elaborate on the impact of any of these or other accomplishments, not listed above.

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3. Looking back, did the [INSERT “MEPI” IF NEEDED] Study of the U.S. Summer Institute program help you improve your own skills in these areas? Please check one box in each row.

	No, not at all	A little	Somewhat	A good deal
[Insert Skill 1]
[Insert Skill 2]
[Insert Skill 3]
[Insert Skill 4]
[Insert Skill 5]

4. If so, please give examples of how you have used these improved skills.

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5. Thinking about your community service experience in particular, please rate how valuable it was for:

	Not at all valuable	Slightly Valuable	Generally Valuable	Very valuable	Extremely valuable
[Insert Objective 1]
[Insert Objective 2]
[Insert Objective 3]

6. Have you used the skills or experience gained during the program to do any of the following? Please check one box in each row.

	Yes	No
Participate in community service, if you hadn’t done so before you left.
Share leadership skills, if you hadn’t done so before you left.
Use leadership skills in various activities, if you hadn’t done so before you left.

7. For each activity listed below, please indicate the most recent role you played. Please check one box in each row.

Activity	Attend meetings	Plan activities and events	Train others	Serve in a leadership position	Start a new group or organization	Other	Did not participate in this activity
Community service
Civic activism
Political activism
Culture (arts, dance, drama, music)
Religious activities
Student clubs or organizations
Student journalism
Work with NGOs

8. If you can, please describe some of your recent activities (for example, a recent event you attended or organized, or a project you worked on).

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9. Since the completion of our program, have you faced any obstacles in reaching or accomplishing your goals? Have you been able to surmount these? Please provide examples, as appropriate.

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10. As a direct result of your participation in the exchange program, have you done or received any of the following at school or university? Please check one box in each row.

	Yes	No
Higher level of responsibilities or leadership at school/university
Organized or initiated new activities or projects at school/university
Established a new organization at school/university

11. As a direct result of your participation in the exchange program, have you done or received any of the following in your community? Please check one box in each row.

	Yes	No
Assumed a leadership role or position in your community
Organized or initiated new activities or projects in your community
Established a new organization in your community

12. Have you used the knowledge or experience gained in the program to initiate any of these formal or informal changes in your community? Please check one box in each row.

	Yes	No
Increased volunteer activities/community service
Founded an NGO or new organization
Introduced new ideas and knowledge
Introduced new initiatives, new ways of doing things
Established new exchanges
Tried to influence public opinion about the United States through the media
Established joint ventures, organizational partnerships, or linkages
Introduced new policies or procedures
Introduced new curricula, pedagogical methods, or educational standards
Became elected or appointed to a local, regional or national government position
Proposed, wrote, and/or passed a new law or treaty

13. Below is a list of different skills and abilities a leader might have. Please rate yourself as either poor, fair, good or excellent on the following characteristics. Please check one box in each row.

	Poor	Fair	Good	Excellent
Being self-reliant, being independent, relying on yourself
Speaking in public
Listening to other people’s suggestions or concerns
Expressing ideas and feelings
Working closely with people different from you
Leading a team and motivating others
Being flexible
Solving problems
Planning for the future
Managing your time
Managing money
Discussing your beliefs/values
Willing to make changes in your community

14. How much do you agree/disagree with the following statements about you as an individual? Please check one box in each row.

	Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree
I feel I have many choices in my life.
I feel I can make a difference in my family.
I feel I can make a difference in my community.
I feel I can influence people around me.

15. Upon reflection, what has participation in the program meant to you personally?

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16. Have you shared your program experience or the knowledge you gained during your exchange in any of the following ways? Please check one box in each row.

	Yes	No
Participated in media interviews (newspaper, television, radio, internet)
Gave presentations to community, neighborhood, school or university groups
Wrote newspapers articles, including editorials and opinion pieces.
Wrote academic books
Wrote non-academic books
Wrote academic articles—for journals or academic publications
Other (please write in):

17. How do you view the United States government and its relationship with your home country?

	Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree
The U.S. government is a trustworthy partner for my country.

18. How do you view the U.S. Government and the American people? Please check one box in each row.

	Strongly Unfavorable	Generally Unfavorable	Neither favorable or unfavorable	Generally Favorable	Strongly Favorable
U.S. government
American people

19. To what extent do you agree or disagree with the statements below?

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
Voting is important because real decisions are made in elections.
Free and fair elections are the cornerstone of democracy.
An independent media is important to the free flow of information.
All citizens in a country should have equal rights and protections under the law, regardless of circumstances.
The Rule of Law is fundamental to a functioning democracy.
Individuals and organizations have the right to free speech and to voice opposition.
Democratic principles enhance the workplace. Supervisors should incorporate democratic principles into their management practices.

20. Have you remained in contact with people you met during your exchange program?

	
Yes
No

21. If yes, with whom have you remained in contact? Please check one box in each row.

	Yes	No
Other Institute program participants
Institute staff/program administrators
Institute Faculty
Student facilitators
Other students
Americans in the community whom you met
U.S. State Department staff in Washington D.C.
U.S. Embassy staff
Other (specify) __________________________

22. Have you continued to study and learn about the country you visited?

	
Yes
No

23. Do you plan to seek other opportunities for study abroad?

	
Yes
No

24. Have you encouraged friends to travel or study abroad?

	
Yes
No

25. Geographic location:

I live in…	
My country’s capital city	
Another major city in my country other than the capital	
A small city, town or rural location in my country	

26. Home country: [Drop Down List]

27. Date of birth (day/month/year) Ex: 20/10/1978: _________________

28. Sex:

	
Female
Male

29. What is your ethnic background? _________________

30. Which language do you consider to be your native language/mother tongue? _________________

31. What religious group do you consider yourself a member of or feel closet to? (Please check one.)

			
Baha’ism		Shintoism
Buddhism		Sikhism
Christianity		Taoism
Confucianism		Zoroastrianism
Hinduism		Not close to any group
Islam		None
Jainism		Other: (please write in) ____________________
Judaism

32. Do you know about and have you registered for the State Department Alumni website, https://alumni.state.gov?

	
Yes, I know about it and I have registered
Yes, I know about it but I have not yet registered
Yes, I know about it but I do not plan to register
No, I do not know about it

33. Thank you for completing this survey! If you have additional comments you would like to make, please do so here.

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34. How long did it take you to complete this survey? ______ Minutes

12 OMB No.: 1405-0158

Control No: SV2007-0017

Expiration Date: 02/29/08

Estimated Burden Time: 30 minutes