SV-2007-0018 MEPI Study of the United States Institutes 2007 (Pre-pro

Middle East Partnership Initiative (MEPI)

Study of the U.S. Institute for Undergraduate Student Leaders 2007

[Program Name]

U.S. Pre-Program Exchange Survey

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 twenty (20) 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/ISS/DIR, U.S. Department of State, Washington, D.C. 20520.

1. In your own words, what do you see as the primary goals of the MEPI Study of the United States Summer Institute program?

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2. There are many different reasons for participating in the MEPI Study of the United States Summer Institute program. In the table below, please choose the three most important to you.

	
[Insert Institute specific program goal 1]
[Insert Institute specific program goal 2]
[Insert Institute specific program goal3]
[Insert Institute specific program goal 4]
[Insert Institute specific program goal 5]
[Insert Institute specific program goal6]
Other (Please write in)

3. 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
Being tolerant of others different than you
Leading a team and motivating others
Being flexible
Solving problems
Planning for the future
Managing your time
Managing your money
Discussing your beliefs/values
Willing to make changes in your community

4. Please rate your current knowledge and understanding of the following topics and themes highlighted in your MEPI Study of the US Summer Institute program. Please check one box in each row.

	No Knowledge	Less Than Basic	Basic Knowledge	Beyond Basic	Advanced Knowledge
Leadership
Community service
Political engagement and activism
The structure of the United States government
The history of the United States
The role of an independent media in American society
United States economy
Business practices in the United States
American values, society and culture

5. While you are in U.S., do you think you will increase your knowledge and understanding of the following topics and themes highlighted in your MEPI Study of the US Summer Institute program? Please check one box in each row.

	No, not at all	A little	Somewhat	A good deal	Not sure
Leadership
Community service
The structure of the United States government
The history of the United States
The role of an independent media in American society
United States economy
Business practices in the United States
American values, society and culture
The structure of the United States government

6. Please rate your current skills in these areas. Please check one box in each row.

	Poor	Fair	Good	Excellent
Read English
Speak English
Write English
Make presentations in English
Use the internet for research

7. What do you see yourself as accomplishing or learning, during this exchange visit, that you could not accomplish or learn at home?

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

	Strongly Agree	Somewhat Agree	Neither Agree nor Disagree	Somewhat Disagree	Strongly Disagree
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

9. Please rate your knowledge or understanding of the following topics. Please check one box in each row.

	No Knowledge	Less Than Basic	Basic Knowledge	Beyond Basic	Advanced Knowledge
United States democracy
United States economy
American values and culture
Religious and ethnic diversity United States
Freedom of speech and press in United States
Voluntary community service in United States
Daily life in United States

10. How do you view the United States Government and the American people? Please check one box in each row.

	Strongly Unfavorable	Generally Unfavorable	Neither Favorable nor Unfavorable	Generally Favorable	Strongly Favorable
United States government
American people

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

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
The United States government is a trustworthy partner for my country

12. What is the first positive thing you think about when you think about the United States.?

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13. What is the first negative thing you think about when you think about the United States.?

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14. Please respond with your evaluation of the following statements about the United States. Please check one box in each row.

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
Americans rely on a system of laws to protect the individual
Americans are materialistic
The United States is a violent country where people do not feel safe
The United States is a well-functioning democracy
Americans are not well informed about my region of the world
Americans are not a religious people
Americans are family-oriented
Americans play an active role in their communities
The United States provides equal opportunities for all
The United States has even-handed policies toward Muslim countries
The United States imposes its views on other countries

15. To what extent do you agree or disagree with the statements below? Please check one box in each row.

	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

16. What year of university/college have you most recently completed?

1st year	2nd year	3rd year	4th year	5th year

17. What is your major field of study?

	
Athletics
Arts and humanities (history, languages, literature, art, theater, etc.)
Business administration, finance
Computer science, information technology
Education
Engineering
Environment
Government
Humanitarian affairs, development assistance, conflict resolution
International relations
Labor, trade unions
Law, judicial, law enforcement
Library and information science
Media, mass communications, journalism, communication technology, advertising, graphics
Medicine
Military service
Public administration
Public health
Religion
Science (physics, math, chemistry, biology, astronomy, geography, agronomy, etc.)
Social sciences (sociology, economics, psychology, political science, etc.)
Social work
Teaching English, English language instruction
Teaching (general)
Not sure
Other (Please write in)

18. Home city/town: _________________

19. Geographic location:

	
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

20. Age: (Drop Down)

21. Sex:

	
Female
Male

21. Which religion do you most closely identify with?

			
Baha’ism		Shintoism
Buddhism		Sikhism
Christianity		Taoism
Confucianism		Zoroastrianism
Hinduism		Not close to any group
Islam		Other: (Please write in)
Jainism
Judaism

23. Thank you for completing this survey! If you have additional comments you would like to make, about any of the things above, about your participation so far, about what you have been proud to share, or something we haven’t touched upon, please do so here. We value your thoughts very much.

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23. How long did it take you to complete this survey? ______minutes

11 OMB No.:1405-0158

Control No: SV-2007-0018

Expiration Date: 02/29/08

Estimated Burden Time: 20 minutes