(Examples of OMB Approved Customer Surveys)
EXAMPLE 1:
The Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention
Client Survey
Please answer the following questions about your experiences with the Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention (hereafter referred to as the Center).
I. Institution and Respondent Description
1. How many undergraduates are enrolled at your institution?
O Fewer than 1,000
O 1,000 to 4,999
O 5,000 to 9,999
O 10,000 to 19,999
O 20,000 or more
2. Which of the following best describes your institution?
O Public O Private
3. Which of the following best describes your institution?
O 2-Year O 4-Year
4. Which of the following best describes your institution?
O Commuter O Residential
5. Which of the following best describes your institution’s geographic location?
O Urban O Suburban O Rural
6. Does your state have a statewide alcohol and other drug (AOD) prevention initiative?
O Yes O No O Don’t Know
7. Which of the following best describes your position?
O AOD Prevention Coordinator
O Administrator
O Faculty
O Other Staff
O Student
O Other (please specify): _______________________________________
8. Which of the following best describes the college/university sector in which you work (choose one)?
O Student Life
O Housing
O Greek Life
O Health Services
O President's Office
O Faculty
O Psychological Services
O Athletics
O Security
O Other (please specify): _______________________________________
Center Services
Have you ever used any of the Center’s services? Services include their Web site, HEC/News service, printed publications, technical assistance, and/or trainings conducted by Center staff.
O Yes O No O Don’t Know
If NO or DON’T KNOW – SKIP TO:
1. What types of services or resources would you ideally like to receive from a national resource center on college-level alcohol and other drug abuse and violence prevention?
To learn more about the Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention, please visit their Web site at: www.higheredcenter.org
Thank you for your participation! Your survey is complete.
IF YES:
Section 1: Overall Accessibility and Usefulness of Center staff and services
2. How long have you been accessing Center services (including the Web site, printed publications, HEC/News service, trainings, and/or technical assistance)?
O Less than 1 year O 1 year to less than 2 years O 2 years to less than 3 years O More than 3 years
3. About how many times did you access services from the Center last year?
O 0 times O 1 – 2 times O 3 – 5 times O 6 – 10 times O 11 + times
4. Overall, how would you rate the accessibility of Center staff and services?
O Excellent O Good O Fair O Poor
5. To what extent do you agree with the following statements?
|
Strongly Agree |
Somewhat Agree |
Somewhat Disagree |
Strongly Disagree |
It is easy to reach staff at the Center by phone. |
O |
O |
O |
O |
It is easy to reach staff at the Center by e-mail. |
O |
O |
O |
O |
It is easy to identify the appropriate Center staff member to answer my question. |
O |
O |
O |
O |
6. Based on your experiences to date, how do you rate the importance of the Center as a resource to you?
O High Importance O Moderate Importance O Low Importance O Not Important
Section 2: Individual Services
The survey will ask you whether you have used each of the following five Center services - Web site, HEC/News service, publications, technical assistance, and training - followed by a few brief questions about each.
A. Center Web Site
1. Have you ever used the Center’s Web site? O Yes O No
If No, skip to next Center service
If Yes:
2. How often do you access the Center’s Web site?
O Daily O Weekly O Every few weeks O Monthly
O Every few months O Every 6 months O Annually
3. Please rate each of the Center’s Web site pages on key topic areas in terms of their importance to your work.
|
High Importance |
Moderate Importance |
Low Importance |
Not Important |
Environmental management strategies |
O |
O |
O |
O |
Statewide AOD prevention initiatives |
O |
O |
O |
O |
Alcohol use on campus |
O |
O |
O |
O |
Other drug use on campus |
O |
O |
O |
O |
Violence prevention on campus |
O |
O |
O |
O |
Social norms and social norms marketing |
O |
O |
O |
O |
Screening, early intervention, treatment, and recovery strategies |
O |
O |
O |
O |
Evaluation of prevention programs |
O |
O |
O |
O |
Evaluation resources |
O |
O |
O |
O |
Completing the Biennial Review |
O |
O |
O |
O |
Complying with Drug-Free Schools and Communities Act (DFSCA) |
O |
O |
O |
O |
4. Please rate each of the Web site pages on Center services in terms of their importance to your work.
|
High Importance |
Moderate Importance |
Low Importance |
Not Important |
AODV information and technical assistance |
O |
O |
O |
O |
Training modules |
O |
O |
O |
O |
HEC/News (subscription information; archives) |
O |
O |
O |
O |
Publications (access online or order copies) |
O |
O |
O |
O |
Information about and links to The Network |
O |
O |
O |
O |
Information about the Department of Education’s National Meeting |
O |
O |
O |
O |
“This Week!” home page feature |
O |
O |
O |
O |
“What Campuses and Communities Are Doing” program summaries |
O |
O |
O |
O |
Information about grant opportunities |
O |
O |
O |
O |
Job Opportunities |
O |
O |
O |
O |
Calendar of Events |
O |
O |
O |
O |
5. How would you rate the quality of content on the Center’s Web site?
O Excellent O Good O Fair O Poor
How would you rate the Web site for ease of use and navigability?
O Excellent O Good O Fair O Poor
7. How would you rate the overall usefulness of the Center’s Web site?
O Highly Useful O Moderately Useful O A Little Useful O Not Useful
8. How important to you is the Center’s Web site for the following purposes:
|
High Importance |
Moderate Importance |
Low Importance |
Not Important |
To educate self or support own prevention efforts |
O |
O |
O |
O |
As reference when writing reports or grant proposals |
O |
O |
O |
O |
As reference or handouts for workshops, meetings, and/or retreats |
O |
O |
O |
O |
As reference or handouts for courses/classes |
O |
O |
O |
O |
To enlist support of senior college administrators for making AOD prevention a priority |
O |
O |
O |
O |
To enlist support of key community leaders for making AOD prevention a priority |
O |
O |
O |
O |
To build support for environmental approaches to AOD Prevention |
O |
O |
O |
O |
To increase faculty buy-in |
O |
O |
O |
O |
Assistance with the Biennial Review (DFSCA) |
O |
O |
O |
O |
Other (please specify): ________________________
|
O |
O |
O |
O |
In what ways could the Center improve its Web site? Please provide suggestions regarding content and/or navigability.
B. HEC/News: The Higher Education Center News List – HEC/News is an electronic mailing list used by the Center to disseminate news stories related to alcohol and other drug abuse and violence prevention in higher education. Subscribers to HEC/News choose to receive either daily or weekly notices, keeping up-to-date on the latest issues and concerns around college AODV prevention across the country.
1. Have you ever received HEC/News? O Yes O No
If No, skip to next Center service
If Yes:
Are you currently subscribed to HEC/News?
O Yes, Daily Update O Yes, Weekly Updates O No
How often do you read HEC/News?
O Every time O Most of the time O Some of the time O Rarely or Never
4. Overall, how would you rate the quality of HEC/News?
O Excellent O Good O Fair O Poor
5. How would you rate HEC/News for ease of use?
O Excellent O Good O Fair O Poor
6. How often do you pass HEC/News e-mails along to others in your institution and/or community?
O Frequently O Occasionally O Rarely O Never
7. In what ways could the Center improve HEC/News?
C. Printed Publications
1. Have you ever used any of the Center’s publications? O Yes O No
If No, skip to next Center service
If Yes:
2. Overall, how would you rate the quality of the Center’s materials and publications?
O Excellent O Good O Fair O Poor
3. How often do you pass the Center’s printed materials along to others in your institution and/or community?
O Frequently O Occasionally O Rarely O Never
4. Which format would be most useful to you for obtaining Center materials and publications?
O Hard copy O Download copy (pdf) O CD
5. In what ways could the Center improve its materials and publications?
6. Are there any topics for which you would like to see new materials or publications developed?
D. Information and Technical Assistance – By technical assistance, we mean any help that you may have received from Center staff regarding implementation and/or evaluation of alcohol or other drug abuse or violence prevention or early intervention strategies.
1. Have you ever received technical assistance from the Center? Check all that apply.
O Yes, by phone
O Yes, by e-mail
O Yes, in-person or on-site
O No
O Don’t know
If No, skip to next HEC service
If Yes or Don’t Know:
2. Overall, how responsive has the Center been to your specific technical assistance needs?
O Very Responsive O Somewhat Responsive O Somewhat Unresponsive O Very Unresponsive
3. In what ways could the Center improve its technical assistance services?
Please indicate whether or not you have used any of the following technical assistance services from the Center. If you answer "yes", please rate the quality of the service received.
|
Have you received any of the following technical assistance services? |
If YES, how would you rate the quality of the Center service? |
|||||
|
YES |
NO |
Don’t Know |
Excellent |
Good |
Fair |
Poor |
General information about alcohol and other drug abuse prevention |
O |
O |
O |
O |
O |
O |
O |
General information about violence prevention |
|
|
|
|
|
|
|
Assistance in locating outside experts and/or resources |
O |
O |
O |
O |
O |
O |
O |
Grant-writing assistance (including help in locating funding sources) |
O |
O |
O |
O |
O |
O |
O |
Help with AOD prevention program development |
O |
O |
O |
O |
O |
O |
O |
Help with AOD policy development |
O |
O |
O |
O |
O |
O |
O |
Help with violence prevention program development |
O |
O |
O |
O |
O |
O |
O |
Help with violence prevention policy development |
O |
O |
O |
O |
O |
O |
O |
Assistance with evaluation activities |
O |
O |
O |
O |
O |
O |
O |
Help with Biennial Review (DFSCA) |
O |
O |
O |
O |
O |
O |
O |
Use literature review from Web site |
O |
O |
O |
O |
O |
O |
O |
Center staff participation in your events |
O |
O |
O |
O |
O |
O |
O |
Other technical assistance (please specify): ______ |
O |
O |
O |
O |
O |
O |
O |
E. Training
1. Have you ever attended a training conducted by Center staff?
O Yes O No
If No, Skip to Overall Section (Last Section)
If Yes:
Please indicate whether or not you have attended any of the following Center trainings. If you answer "yes", please indicate how satisfied you were with the service.
|
Have you received any of the following trainings? |
If YES, how would you rate the quality of the Center training? |
||||
|
YES |
NO |
Excellent |
Good |
Fair |
Poor |
Training Progression: Building Momentum (1 day) |
O |
O |
O |
O |
O |
O |
Training Progression: Moving to Action (1 day) |
O |
O |
O |
O |
O |
O |
Using Policy to Create Change (1/2 day) |
O |
O |
O |
O |
O |
O |
Strategic Planning: Move Your Prevention Efforts Forward (2 days) |
O |
O |
O |
O |
O |
O |
Other training (please specify): ______________ |
O |
O |
O |
O |
O |
O |
3. Overall, how responsive has the Center been to your specific training needs?
O Very Responsive O Somewhat Responsive O Somewhat Unresponsive O Very Unresponsive
4. In what ways could the Center improve its training services?
5. How likely would you be to access online training from the Center?
O Very Likely O Somewhat Likely O Somewhat Unlikely O Very Unlikely
Section 3. Overall (Final Section)
Please indicate whether your institution has accomplished the following. If you answer "yes", please indicate how important the Center has been in making your effort possible.
|
Has your institution accomplished the following? |
IF YES, how important was the Center in making your effort possible? |
|||||
|
YES |
NO |
Don’t Know |
High Importance |
Moderate Importance |
Low Importance |
Not Important |
Initiated or participated in a campus task force |
O |
O |
O |
O |
O |
O |
O |
Initiated or participated in a campus-community coalition |
O |
O |
O |
O |
O |
O |
O |
Initiated or participated in a statewide or regional prevention coalition |
O |
O |
O |
O |
O |
O |
O |
Applied for funding to support environmental approaches to prevention |
O |
O |
O |
O |
O |
O |
O |
Participated in a statewide prevention exchange, forum, or conference |
O |
O |
O |
O |
O |
O |
O |
Developed a strategic plan for environmentally-based AOD prevention efforts |
O |
O |
O |
O |
O |
O |
O |
Developed new AODV policies |
O |
O |
O |
O |
O |
O |
O |
Increased enforcement of existing AODV policies |
O |
O |
O |
O |
O |
O |
O |
Restricted alcohol marketing and promotion |
O |
O |
O |
O |
O |
O |
O |
Created and promoted alcohol-free options |
O |
O |
O |
O |
O |
O |
O |
Conducted social norms marketing |
O |
O |
O |
O |
O |
O |
O |
Changed the normative environment (e.g., scheduling morning and Friday classes; substance-free housing; correcting misperceptions of student AOD use) |
O |
O |
O |
O |
O |
O |
O |
Restricted alcohol availability |
O |
O |
O |
O |
O |
O |
O |
Conducted brief intervention strategies (e.g., BASICS, motivational interviewing, E-CHUG) |
O |
O |
O |
O |
O |
O |
O |
Other (please specify): ________________ |
O |
O |
O |
O |
O |
O |
O |
2. Please feel free to elaborate on the importance of the Center in making these efforts possible.
3. Which of the following Center services do you use for the following purposes? Select all that apply.
|
HEC / News |
Publications |
Technical Assistance |
Training |
To educate self or support own prevention efforts |
O |
O |
O |
O |
As reference when writing reports or grant proposals |
O |
O |
O |
O |
As reference or handouts for workshops, meetings, and/or retreats |
O |
O |
O |
O |
As reference or handouts for courses/classes |
O |
O |
O |
O |
To enlist support of senior college administrators for making AOD prevention a priority |
O |
O |
O |
O |
To enlist support of key community leaders for making AOD prevention a priority |
O |
O |
O |
O |
To build support for environmental approaches to AOD prevention |
O |
O |
O |
O |
To increase faculty buy-in |
O |
O |
O |
O |
Assistance with the Biennial Review (DFSCA) |
O |
O |
O |
O |
Other (please specify): ________________________
|
O |
O |
O |
O |
THANK YOU FOR COMPLETING THIS SURVEY!
Paperwork Burden Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1800-0011. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4700. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Office of Safe and Drug-Free Schools, U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202-6450. The expiration date for this approval is August 31, 2009.
EXAMPLE 2:
FORM
APPROVED O.M.B.
NO.: 1800-0011
EXPIRATION
DATE:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1800-0011. The time required to complete this information collection is estimated to average 15x minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Office of the Deputy Secretary, U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202-0600.
U.S. Department of Education
The Department of Education (ED) is committed to serving and satisfying its customers. To this end, we have commissioned the CFI Group, an independent third-party research group, to conduct a survey that asks about your satisfaction with ED’s products and services and about ways that we can improve our service to you.
The CFI Group and the Department of Education will treat all information in a secure fashion and will only provide aggregate results to Department personnel. All information you provide will be combined with information from other respondents for research and reporting purposes. Your individual responses will not be released. This brief survey will take about 15 minutes of your time.
If you have any questions about this survey, please contact Jeanne Nathanson, 202-401-0618. Jeanne.Nathanson@ed.gov.
This interview is authorized by the U.S. Office of Management and Budget Control No. 1800-0011.
Please note that ALL questions on this survey (unless noted otherwise) refer to your experiences over the PAST 12 MONTHS.
Please click on the "Next" button below to begin the survey.
Q1. Please indicate your current program office.
1. Chief State School Officers (ASK CSSO1.)
2. OELA – Title III State Directors (SKIP TO STAFF1)
3. OESE – State Educational Technology Directors (SKIP TO STAFF1)
4. OESE – State Title I Directors (SKIP TO STAFF1)
5. OESE – State Title V, Part A Directors (SKIP TO STAFF1)
6. OSERS/OSEP – Lead Agency Early Intervention Coordinators (SKIP TO STAFF1)
7. OSERS/OSEP – State Directors of Special Education (SKIP TO STAFF1)
8. OPEPD – EDEN/EDFacts Coordinators (SKIP TO STAFF1)
9. OVAE – Career and Technical Education State Directors (SKIP TO STAFF1)
10. OVAE – Directors of Adult Education and Literacy (SKIP TO STAFF1)
11. None of the above currently applies (SKIP TO END)
(ask Q2 only if Q1= 1.Chief State School Officers)
Q2. Do you have regular contact with a senior ED officer who can respond to your policy and programmatic questions?
Yes
No
Please think about the interactions you have had with senior ED officers and/or other ED staff.
PLEASE NOTE: This does not include ED-funded technical assistance providers, such as regional labs, national associations, contractors, etc.
(ALL PROGRAMS OTHER THAN CHIEF STATE SCHOOL OFFICES START WITH Q3)
On a scale from 1 to 10, where “1” is “Poor” and “10” is “Excellent,” please rate the senior ED officers’ and/or other ED staff’s:
Q3. Knowledge of relevant legislation, regulations, policies, and procedures
Q4. Responsiveness to your questions
Q5. Accuracy of responses
Q6. Sufficiency of legal guidance in responses
Q7. Consistency of responses with ED staff from different program offices
Q8. Collaboration with other ED program offices in providing relevant services
(Ask Q9 only if Q8 is rated <6)
Q9. Please identify your state’s best example of collaboration across offices that you would offer as a model for ED.
Q10. Do you have interaction with ED-funded providers of technical assistance (e.g., regional labs, national associations, contractors, etc.) separate from ED staff?
Yes
No (SKIP TO WEB 1.)
Don’t know (SKIP TO WEB 1.)
Please think about your interactions with ED-funded providers of technical assistance. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate their:
Q11. Knowledge of relevant legislation, regulations, policies, and procedures
Q12. Responsiveness to your questions
Q13. Accuracy of responses
Q14. Sufficiency of legal guidance in responses
Q15. Consistency of responses with ED staff
Q16. Collaboration with ED staff in providing relevant services
Q17. Collaboration with other ED-funded providers of technical assistance in providing relevant services.
Please think about your experience using ED’s online resources. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the:
Q18. Ease of finding materials online
Q19. Ease of submitting information to ED via the Web (e.g., grant applications, annual reports, accountability data)
Q20. Now think about how ED uses technology (e.g., conference calls, video-conferencing, Web conferencing, listservs) to deliver its services to you. On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate ED’s effectiveness in using technology to deliver its services.
(Ask Q21 only if Q20 is rated<6)
Q21. Please describe how ED could better use technology to deliver its services.
Q22. Think about how ED is working with the states to develop an automated process to share accountability information. Please rate the quality of this assistance from ED. Use a 10-point scale where “1” is “Poor” and “10” is “Excellent.”
Q23. How effective has this automated process been in improving your state’s reporting? Please use a 10-point scale where “1” is “Not very effective” and “10” is “Very effective.”
Q24. How much of a reduction in federal paperwork do you expect over the next few years because of ED’s initiative to promote the use of technology in reporting accountability data (e.g. EDEN/EDFacts)? Please use a 10-point scale where “1” is “Not very significant” and “10” is “Very significant.”
Think about the documents (e.g., publications, guidance, memoranda) you receive from ED.
On a 10-point scale, where “1” is “Poor” and “10” is “Excellent, please rate the documents’:
Q25. Clarity
Q26. Organization of information
Q27. Sufficiency of detail to meet your program needs
Q28. Relevance to your areas of need
Q29. Comprehensiveness in addressing the scope of issues that you face
Now we are going to ask you to please consider ALL of ED’s products and services and not only those we just asked about.
Q30. Using a 10-point scale on which “1” means “Very Dissatisfied” and “10” means “Very Satisfied,” how satisfied are you with ED’s products and services?
Q31. Now please rate the extent to which the products and services offered by ED have fallen short of or exceeded your expectations. Please use a 10-point scale on which "1" now means "Falls Short of Your Expectations" and "10" means "Exceeds Your Expectations."
Q32. Now forget for a moment about the products and services offered by ED, and imagine the ideal products and services. How well do you think ED compares with that ideal? Please use a 10-point scale on which "1" means "Not Very Close to the Ideal" and "10" means "Very Close to the Ideal."
Now please indicate the degree to which you agree or disagree with the following statement.
Q33. Overall, when I think of all of ED’s products and services, I am satisfied with their quality.
Strongly Agree
Agree
Disagree
Strongly Disagree
Does Not Apply
Q34. In the past 6 months, have you issued a formal complaint to ED to express your dissatisfaction with the assistance you’ve received from an ED staff member?
Yes
No
Q35. Finally, please describe how ED can improve its service to you.
Thank you again for your time. To complete the survey and submit the results, please hit the “Finish” button below. Have a good day!
Think about the particular ways in which you have received technical assistance from the Office of English Language Acquisition (OELA).
Think about the one-on-one consultations you have had with program officers. On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate the effectiveness of the one-on-one consultations in:
Q1. Providing you an interpretation of Title III
Q2. Helping you with your implementation of Title III in your state
Q3. What can OELA do over the next year to meet your state’s technical assistance and program improvement needs?
Think about your experiences seeking information at OELA’s Clearinghouse Web site (www.ncela.gwu.edu). On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate the effectiveness of the Web site in:
Q4. Providing you with the information you needed
Q5. Helping you inform programs serving ELLs in your state
Q6. Think about the working relationship between Title III and Title I.
On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate how effective the Department has been in encouraging collaboration between Title I and Title III.
(Ask only if question is scored <6)
Q7. Please describe how the working relationship between Title III and Title I could be improved.
Think about the Title III Biennial Report that is being used to collect data this cycle and the role of the regional meetings. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the regional meetings for:
Q8. Helping familiarize you with the Biennial Report form
Q9. Allowing for your input and comments for refining the Biennial Report form
2008 – OESE – STATE EDUCATIONAL TECHNOLOGY DIRECTORS
Think about the particular ways in which you have received technical assistance from the Enhancing Education Through Technology Program (EETT).
First, consider the one-on-one consultations with EETT program officers. On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate the effectiveness of the one-on-one consultations in:
Q1. Providing you an interpretation of Title II, Part D (Enhancing Education Through Technology)
Q2. Helping you with your implementation of Title II, Part D (Enhancing Education Through Technology)
Think about the guidance document provided by the EETT program office.
Q3. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate its usefulness.
Think about the Educational Technology State Directors' national meetings (i.e., national technology conferences, SETDA meetings) where the EETT program office made a presentation
Q4. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the usefulness of the information presented at these meetings.
Think about the federal monitoring process as it relates to the Enhancing Education Through Technology program office. On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate the effectiveness of the federal monitoring process in:
Q5. Helping you with your compliance efforts
Q6. Helping you to improve performance results
Think about your working relationship with the Enhancing Education Through Technology program office.
Q7. On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate the effectiveness of this relationship.
(Ask only if question is scored <6)
Q8. Please describe how your working relationship with EETT could be improved.
Q9. What can EETT do over the next year to meet your state’s technical assistance and program improvement needs?
2008 – OESE – STATE TITLE I DIRECTORS
Think about the technical assistance you have received from the Title I office, Student Achievement and School Accountability (SASA). On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the:
Q1. Usefulness of technical assistance on Standards and Assessments, Instructional Support and Fiduciary of Title I, Part A of NCLB
Q2. Usefulness of technical assistance on Neglected and Delinquent
Q3. Usefulness of technical assistance on Even Start
Q4. Usefulness of technical assistance on Homeless Education
Think about the information on monitoring for Title I you have received. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the:
Q5. Availability of information on monitoring for Title I
Q6. Usefulness of information on monitoring for Title I
Q7. Think about how SASA uses electronic communications approaches such as email, Web casts and WebEx to provide you information. On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate SASA’s effectiveness in using technology to provide information.
(Ask only if question is scored <6)
Q8. Please describe how SASA could better use technology to provide information.
Q9. Again, thinking about SASA’s use of electronic communications approaches to provide information: on a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate SASA’s effectiveness in using technology to enhance communication between ED and the state.
Q10. What can SASA do over the next year to meet your state’s technical assistance and program improvement needs?
2008 – OESE – STATE TITLE V, PART A DIRECTORS
Think about the particular ways in which you have received technical assistance from the Title V, Part A (Innovative Programs) office. First, consider the one-on-one consultations with Title V, Part A program officers.
On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate the effectiveness of the one-on-one consultations in:
Q1. Providing you an interpretation of Title V, Part A
Q2. Helping you with your implementation of Title V, Part A
Q3. Think about the guidance document provided by the Title V, Part A program office. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate its usefulness.
Q4. Think about Title V, Part A national meetings and conference calls (including the Steering Committee’s national meetings and the program office’s conference calls for orientation and follow-up to the Steering Committee’s national meetings) where the Title V, Part A program office made presentations. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the usefulness of the information presented by the program office.
Think about the federal monitoring process as it relates to the Title V, Part A program office. On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate the effectiveness of the federal monitoring process in:
Q5. Helping you with your compliance efforts
Q6. Helping you to improve performance results
Q7. Think about your working relationship with the Title V, Part A program office. On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate the effectiveness of this relationship.
(Ask only if question is scored <6)
Q8. Please describe how your working relationship with the Title V, Part A program office could be improved.
Q9. What can the Title V, Part A program office do over the next year to meet your state’s technical assistance and program improvement needs?
2008 – OSERS/OSEP – LEAD AGENCY EARLY INTERVENTION COORDINATORS
Think about the technical support State Contacts from the Monitoring and State Improvement Planning Division of the Office of Special Education Programs provided. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the staff’s:
Q1. Responsiveness to answering questions
Q2. Supportiveness in helping you complete your state’s federally required performance plans/reports/applications
Q3. Dissemination of accurate information
Q4. Dissemination of information in a timely manner
Think about the Technical Assistance and Dissemination Centers from OSEP. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the centers’:
Q5. Responsiveness to answering questions
Q6. Responsiveness to information requests
Q7. Support to positively impact on your State’s SPP improvement targets.
Q8. Think about the Communities of Practice from OSERS. On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate its effectiveness in addressing systems improvement issues of the state.
Q9. What can OSEP do over the next year to meet your state’s technical assistance and program improvement needs?
2008 – OSERS/OSEP – State Directors of Special Education
Think about the technical support State Contacts from the Monitoring and State Improvement Planning Division of the Office of Special Education Programs provided. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the staff’s:
Q1. Responsiveness to answering questions
Q2. Supportiveness in helping you complete your state’s federally required performance plans/reports/applications
Q3. Dissemination of accurate information
Q4. Dissemination of information in a timely manner
Think about the Technical Assistance and Dissemination Centers from OSEP. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the centers’:
Q5. Responsiveness to answering questions
Q6. Responsiveness to information requests
Q7 Support to positively impact on your State’s SPP improvement targets
Q8. Think about the Communities of Practice from OSEP. On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate its effectiveness in addressing systems improvement issues of the state.
Q9. What can OSEP do over the next year to meet your state’s technical assistance and program improvement needs?
2008 – OPEPD – EDEN/EDFACTS COORDINATORS
Think about the support provided by the U.S. Department of Education EDEN/EDFacts team. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the:
Q1. Timeliness of the support
Q2. Usefulness of the support
Q3. Accuracy of information
Q4. Relevance of information
Think about the EDEN/EDFacts data submission process. On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate the effectiveness of the data submission process in:
Q5. Helping you to meet federal mandates for data collection and submission
Q6. Helping you to streamline your federal data collection and submission processes
Q7. Helping you to improve state data collection and submission processes
Q8. How much of a reduction in federal paperwork do you expect over the next few years because of the EDEN data submission process? Please use a 10-point scale where “1” is “Not very significant” and “10” is “Very significant.”
Q9. How much do you expect the data you provide to contribute to improving education performance measurement? Please use a 10-point scale where “1” is “Not very significant” and “10” is “Very significant.”
Q10. Think about the training provided by the EDEN/EDFacts team on data submission. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the training’s usefulness.
Q11. On a 10-point scale where “1” is”, Poor” and “10” is “Excellent,” please rate the support provided by the Department’s Partner Support Center.
Q12. What has been the most significant change to your state data collection and submission process as a result of the EDFacts work?
Q13. How can the Department’s EDFacts team be most helpful to you in meeting federal mandates for data collection, submission, analysis, and reporting in the coming year?
Changes From 2007: None
2008– OVAE – CAREER AND TECHNICAL STATE DIRECTORS
Think about the Consolidated Annual Report (CAR) as a way to report your state’s performance data to OVAE. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the CAR’s:
Q1. User-friendliness
Q2. Compatibility with state reporting systems
If you have been monitored within the last year, think about the federal monitoring process as it relates to your Perkins grant. On a 10-point scale, where “1” is “Not very effective” and “10” is “Very effective,” please rate the effectiveness of the federal monitoring process in:
Q3. Identifying and correcting compliance issues in your state
Q4. Helping you to improve program quality
Think about the national leadership conferences and institutes offered by OVAE. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the information provided at these conferences and institutes on:
Q5. Being up to date
Q6. Usefulness to your program
Q7. Think about the audit resolution process as it concerns OVAE. On a 10-point scale, where “1” is “Not very significant ” and “10” is “Very significant,” please rate its contribution to program improvement.
Q8. Think about the Peer Collaborative Resource Network (PCRN) as it concerns OVAE. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate PCRN’s usefulness to your program.
Think about the State Plan Submission Guide as it concerns OVAE. On a 10 point scale, where “1” is “Poor” and “10” is Excellent,” please rate the State Plan guide submission process on the following:
Q9. User-friendliness
Q10. Compatibility with state reporting systems
Q11. What can OVAE do over the next year to meet your state’s technical assistance and program improvement needs?
Changes From 2007: None
2008 OVAE – DIRECTORS OF ADULT ED AND LITERACY
Think about the National Reporting System as a way to report your state’s performance data to OVAE. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the NRS’s:
Q1. Ease of reporting using the NRS Web-based system.
Q2. Think about the training offered by OVAE through its contract to support the National Reporting System (NRS). On a 10-point scale, where “1” is “Poor” and “10” is “Excellent,” please rate the usefulness of the training.
If you have been monitored, think about the federal monitoring process as it relates to your AEFLA grant. On a 10-point scale, where “1” is,” Not Very Effective” and “10” is “Very effective,” please rate the effectiveness of the federal monitoring process on the following:
Q3. Being well-organized
Q4. Providing pre-planning adequate guidance
Q5. Setting expectations for the visit.
Q6. Using state peer reviewers in the federal monitoring process.
Think about the national meetings and conference offered by OVAE. On a 10-point scale, where “1” is “Poor” and “10” is “Excellent”, please rate the information provided at these conference and institutes on the following:
Q7. Being up-to-date
Q8. Relevance of information
Q9. Usefulness to your program
Think about the national activities offered by DAEL. On a 10-point scale, where “1” is,” Poor” and “10” is “Excellent,” please rate the activities on the following:
Q10. Usefulness of the products in helping your state meet AEFLA program priorities.
Q11. How well the technical assistance provided through the national activities address your program priorities and needs? Please use a 10-point scale where “1” means “does not address needs very well” and “10” means “addresses needs very well.”
Q12. What can DAEL do over the next year to meet your state’s technical assistance/program improvement needs?
Example 3:
U.S. Department of Education
Equity Assistance Centers Program
Client Survey
For Summer 2007 through School Year 2007–2008
Dear Respondent: Your response is essential to help assess and improve the Equity Assistance Centers Program. All responses are confidential. No individual respondents or organizations will be identified. Thank you for your help. If you have any questions, please contact Sandra Meditz at the Library of Congress (phone: 202-707-2888; email: smed@loc.gov).
Instructions
1. Please fill out this electronic form.
2. Save your completed electronic form under a new file name using “Save As.”
3. Return your completed electronic form as an email attachment to patmil@loc.gov by April 18, 2008.
The Equity Assistance Center (EAC) that serves your region is:
[PREFILL THE NAME OF THE EAC FOR THIS RESPONDENT – BIG CAPS & BOLD]
A Few Examples of EAC Services
EACs provide training, planning, consultation, workshops, and other services together with materials and online resources in areas such as, for example:
1. Legal requirements related to non-discrimination on the basis of race, gender, and national origin in education programs.
2. Harassment, hate crimes, racial prejudice, bullying, and civil rights conflicts.
3. Programs for Limited English Proficient (LEP) students.
4. Culturally relevant instruction.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this survey is 1800-0011. The time required to complete this survey is estimated to average 7 minutes per respondent, including the time to review instructions and complete the survey. If you have any comments concerning the accuracy of the time estimate or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202-4700. If you have any comments or concerns regarding the status of your individual submission of this form, write directly to: Office of Elementary and Secondary Education, U.S. Department of Education, Lyndon Baines Johnson Building, 400 Maryland Avenue, SW, Washington, DC 20202.
Did your organization receive services from the EAC anytime during the period from summer 2007 through school year 2007-2008?
a. Yes ¨ (PROCEED TO QUESTION 2)
b. No ¨ (THANK YOU, PLEASE RETURN THE SURVEY)
c. Don’t know ¨ (THANK YOU, PLEASE RETURN THE SURVEY)
As a result of EAC services, did your organization develop, implement, or improve its policies or practices - or both - in any of the following areas? (Check one response in each row.)
|
|
Yes |
No |
Don’t Know |
a. |
Eliminating, reducing, or preventing harassment, conflict, and school violence |
¨ |
¨ |
¨ |
b. |
Reducing over-representation of minorities in Special Education or under-representation of minorities in Gifted and Talented programs |
¨ |
¨ |
¨ |
c. |
Ensuring that students of different race, sex, and national origin have equitable opportunity for high-quality instruction |
¨ |
¨ |
¨ |
d. |
Improving academic opportunities for Limited English Proficient (LEP) students. |
¨ |
¨ |
¨ |
e. |
Ensuring culturally relevant instruction |
¨ |
¨ |
¨ |
Please rate the quality of the EAC products and services you received anytime during the period from summer 2007 through school year 2007-2008. (Check one response.)
Very Low |
Low |
Medium |
High |
Very High |
1 |
2 |
3 |
4 |
5 |
¨ |
¨ |
¨ |
¨ |
¨ |
Please rate the usefulness to your organization’s policies and practices of the EAC products and services you received anytime during the period from summer 2007 through school year 2007-2008. (Check one response.)
Very Low |
Low |
Medium |
High |
Very High |
1 |
2 |
3 |
4 |
5 |
¨ |
¨ |
¨ |
¨ |
¨ |
Why did your organization request services from the EAC instead of choosing another organization? (Use as much space as you need.)
As a result of EAC services, is your organization more effective at meeting its goals in the areas of these services?
Not at All |
Somewhat |
Moderately |
Much |
Very Much |
1 |
2 |
3 |
4 |
5 |
¨ |
¨ |
¨ |
¨ |
¨ |
Please explain and provide any evidence. (Use as much space as you need.)
Does the EAC need to increase or decrease its delivery of the following services, or is the amount of services about right? (Check one answer in each row.)
|
|
More Services Are Needed |
The Amount of Services Is About Right |
Fewer Services Are Needed |
a. |
Tailoring services to meet specific client needs |
¨ |
¨ |
¨ |
b. |
Planning services with clients |
¨ |
¨ |
¨ |
c. |
Identifying Internet website resources |
¨ |
¨ |
¨ |
d. |
Providing materials and other resources |
¨ |
¨ |
¨ |
e. |
Offering conferences, workshops, and seminars |
¨ |
¨ |
¨ |
f. |
Providing video-conferencing or distance-learning services |
¨ |
¨ |
¨ |
Please provide any additional suggestions or comments about EAC products and services. (Use as much space as you need.)
Thank you very much for your participation.
| File Type | application/msword |
| File Title | The Higher Education Center for Alcohol and Other Drug Prevention |
| Author | UMDI Desktop User |
| Last Modified By | kathy.axt |
| File Modified | 2008-04-04 |
| File Created | 2008-04-04 |