Students enrolled in Workforce program(webbased student baseline survey)

Form Approved

OMB No. 0990-

Exp. Date XX/XX/20XX

Attachment 1

Student Survey and Supporting Materials

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 information collection is 0990- . The time required to complete this information collection is estimated to average (0 hours)(20 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 comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

Community College Student Web Survey (baseline version)

Below is a draft set of questions for the baseline version of the Workforce Student Survey, which would be administered to the community college students enrolled in the Workforce Program as they are completing their course of study. This instrument is to serve as a comprehensive survey that can be administered online in approximately 20 minutes.

The survey will start with a login page and then provide an informed consent statement before the actual questions begin.

Preload variables required for survey administration:

Name

Birth Month / Year

Institution

Category	Question Number	Proposed Questions	Response Options
Sample Person Confirmation		Please answer the questions below to help us verify that our records are correct. Our records show that your name is: [PRELOAD NAME] The educational institution you attend/attended for Health IT training is: [PRELOAD INSTITUTION] Is this correct?	Yes (SKIP TO Q3) No
		IF NO… Please edit the information below as appropriate.	DISPLAY PRELOADED NAME AND INSTITUTION FOR EDITING
		What is the month and year of your birth?	MONTH / YEAR [SYSTEM WILL COMPARE ENTRY AGAINST PRELOADED DATE AND CREATE VARIABLE INDICATING WHETHER BIRTHDATE MATCHES.]
Enrollment Information		When did you enroll in the program?	MONTH / YEAR
		Have you completed the program?	Yes (SKIP TO Q7a) No (GO TO Q5a)
	5a.	Are you still enrolled in the program?	Yes (GO TO Q6) No (SKIPTO Q7b)
	6.	IF YES TO Q5a... When do you expect to complete the program?	MONTH / YEAR (SKIP TO Q10)
	7a.	IF YES TO Q5... When did you complete the program?	MONTH / YEAR (SKIP TO Q10)
	7b.	IF NO TO 5a... Do you expect to complete the program?	Yes (GO TO Q8a) No (SKIP TO Q8b)
	8a.	Why did you temporarily leave the program? (Select all that apply.)	Reasons related to time constraints Financial reasons Employment-related reasons (GO TO Q9a) Personal reasons Medical reasons Some other reason – GO TO SPECIFY PROBE IF 6, SPECIFY PROBE: Please provide more detail about why you left the program. OPEN-ENDED (IF 8a NOT 3, SKIP TO Q10)
	8b.	Why did you leave the program? (Select all that apply.)	No longer interested in the field of health IT Time constraints Financial reasons Employment-related reasons (GO TO Q9a) Personal reasons Not receiving the education I felt I needed. Not satisfied with the program instructors. Not satisfied with the courses. Not able to successfully complete assignments and exams. Some other reason - GO TO SPECIFY PROBE IF 10, SPECIFY PROBE: Please provide more detail about why you left the program. OPEN-ENDED (IF 8b NOT 4, SKIP TO Q10)
	9a.	IF 8a=3 or 8b=4... Since leaving the program have you accepted or started a new job?	Yes (GO TO 9b) No (SKIP TO Q10)
	9b.	My new position is:	In the field of health IT Health care-related, but not in the field of health IT In the field of IT, but not in health care A position that is not related to IT or health care
Background Information		What motivated you to enter the program? (Select all that apply.)	To improve my skills/knowledge for my current job To increase my opportunities for promotion or advancement in my current job To help me prepare for the Competency exam [BRIEF DEFINITION OF EXAM TO BE ADDED AT A LATER DATE] To help me obtain a new job For personal interest Some other reason - GO TO SPECIFY PROBE IF 4, SPECIFY PROBE: What type of job? OPEN-ENDED IF 6, SPECIFY PROBE: Please briefly state your reason for entering the program. OPEN-ENDED
		IF MORE THAN ONE SELECTED IN Q10... Which of the following was your primary motivation?	DISPLAY ONLY THOSE RESPONSES CHOSEN AT Q10
		How did you learn about the program? (Select all that apply.)	Advertisement about the program (e.g., poster, radio, TV, web, etc.) News report about health IT education or jobs Orientation program that I attended Conversation with a student or instructor Career counselor Family member or friend Mentioned in registration materials/course catalogue Some other way - GO TO SPECIFY PROBE IF 8, SPECIFY PROBE: Please briefly state how you learned about the program. OPEN-ENDED
Education		Prior to enrolling in the program, what was the highest level of education you achieved? (Select only one.)	High school diploma or GED Some college, but no degree Associate’s degree Bachelor's degree Graduate or professional degree - GO TO SPECIFY PROBE IF 5, SPECIFY PROBE: What type of graduate or professional degree do you hold? OPEN-ENDED
		Prior to entering the program, did you have any formal education or training in any of the following areas?	Health care – GO TO SPECIFY PROBE IT – GO TO SPECIFY PROBE Health IT – GO TO SPECIFY PROBE None of the above IF 1, 2, or 3, SPECIFY PROBE: Please list the name of the education or training program and any credentials or certificates you have received. OPEN-ENDED
		For which of the following health IT roles did you receive training? (Please select all that apply.)	THIS WILL BE PRE-PROGRAMMED WITH THE SPECIFIC HITECH WORKFORCE ROLE-SPECIFIC TRAINING PROGRAMS OFFERED BY EACH COLLEGE, INCLUDING A ‘NOT SURE’ OPTION. SPECIFY PROBE ASKED OF EVERYONE: What was your primary reason for choosing to train in this specific role? OPEN-ENDED
Employment		Which best describes your current employment status.	Employed full-time Employed part-time Self-employed Student (Not currently employed) Other – GO TO SPECIFY PROBE IF 5, SPECIFY PROBE: How would you describe your current employment status? OPEN-ENDED
		IF CURRENTLY WORKING (Q16≠4,5)… Which of the following best describes your current job? (Select only one.) If you hold more than one job, describe your primary job.	In the field of health IT Health care-related, but not in the field of health IT In the field of IT, but not in health care A position that is not related to IT or health care IF 1, 2, OR 3 SPECIFY PROBE: Please indicate the number of years you have worked in this area. NUMERIC TEXT BOX RESPONSE
		IF WORKING IN HEATH IT (Q17=1)... Please provide your current job title.	OPEN-ENDED
		IF WORKING IN HEATH IT (Q17=1)... Please give a brief description of your duties and responsibilities in this position.	OPEN-ENDED
		IF WORKING IN HEATH IT (Q17=1)... What is the name of your employer?	OPEN-ENDED
		IF NOT WORKING OR NOT WORKING IN A HEALTH AND/OR IT JOB (IF Q16=4,5 OR IF Q17=4)… Please indicate whether you have ever held a job that meets one of the following descriptions? (Select all that apply.)	In the field of health IT Health care-related, but not in the field of health IT In the field of IT, but not in health care None of the above IF Q21≠1 SKIP TO Q25.
		IF HISTORY OF A JOB IN THE FIELD OF HEALTH IT (Q21=1)... Please state your job title in this health IT position. If you have held more than one job in health IT, please state your most recent title.	OPEN-ENDED
		IF HISTORY OF A JOB IN THE FIELD OF HEALTH IT (Q21=1)... Please give a brief description of your duties and responsibilities in that position.	OPEN-ENDED
		IF HISTORY OF A JOB IN THE FIELD OF HEALTH IT (Q21=1)... What was the name of your employer?	OPEN-ENDED
		IF CURRENTLY WORKING (Q16≠4,5)… During a typical week, how many hours do you work in your current job? If you hold more than one job, please report the number of hours worked on your primary job.	HOURS PER WEEK
Experience with the Learning Environment		IF Q5a=1: Are your health IT courses generally online or in-person? (Select only one.) IF Q5=1 or Q5a=2: Were your health IT courses generally online or in-person? (Select only one.)	Exclusively in-person (in the classroom or lab) Mostly in-person An even mix of in-person and online Mostly online Exclusively online Some other format IF 6, SPECIFY PROBE: How would you describe the format in which you took your courses? OPEN-ENDED IF Q26=4 or 5 SKIP TO Q28
		Please indicate whether you strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, or strongly disagree with the following statements. IF Q5a=1: In general, active class participation by individuals is encouraged in my health IT program. IF Q5=1 or Q5a=2: In general, active class participation by individuals was encouraged in my health IT program.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
		Please indicate whether you strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, or strongly disagree with the following statements. If Q5a=1: The courses meet my general expectations of the program. If Q5=1 or Q5a=2: The courses met my general expectations of the program.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
		The individual courses required for this program fit together to form a cohesive training program.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
		IF Q5a=1: My courses give me a clear understanding of the subject matter. IF Q5=1 or Q5a=2: My courses gave me a clear understanding of the subject matter.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
		IF Q5a=1: On the whole, I feel my instructors are knowledgeable in the subject matter. IF Q5=1 or Q5a=2: On the whole, I feel my instructors were knowledgeable in the subject matter.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
		IF Q5a=1: On the whole, I feel my instructors are effective teachers. IF Q5=1 or Q5a=2: On the whole, I feel my instructors were effective teachers.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
		IF Q5a=1: If I had questions about course content or assignments, I feel confident that an instructor or program staff person would be able to answer them. IF Q5=1 or Q5a=2: If I had questions about course content or assignments, I feel confident that an instructor or program staff person would have been able to answer them.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
		IF Q5a=1: Overall, my instructors’ assignments and exams reflect the course material we covered. IF Q5=1 or Q5a=2: Overall, my instructors’ assignments and exams reflected the course material we covered.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
		IF Q5a=1: The way the program is organized accommodates my other personal and professional commitments. IF Q5=1 or Q5a=2: The way the program was organized accommodated my other personal and professional commitments.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
		IF Q5a=1: How satisfied are you with your overall experience with your program? IF Q5=1 or Q5a=2: How satisfied were you with your overall experience with your program?	Very satisfied Somewhat satisfied Not too satisfied Not at all satisfied
Perceptions about work/skills readiness		IF NOT WORKING OR NOT WORKING IN HEALTH IT (Q16=4,5 OR IF Q17≠1)… IF Q5a=1The skills I am learning will help me obtain the type of position in Health IT I am seeking. IF Q5=1 or Q5a=2: The skills I learned will help me obtain the type of position in health IT I am seeking.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
		IF NOT WORKING OR NOT WORKING IN HEALTH IT (Q16=4,5 OR IF Q17≠1)… IF Q5a=1: The skills I am learning will help me perform well in the type of health IT job I am seeking. IF Q5=1 or Q5a=2: The skills I learned will help me perform well in the type of health IT job I am seeking.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree SKIP TO Q41
		IF WORKING IN HEALTH IT (Q17=1)… IF Q5a=1: In general, I feel the skills I am learning in the program will improve my job performance. IF Q5=1 or Q5a=2: In general, I feel the skills I learned in the program will improve my job performance.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
		IF WORKING IN HEALTH IT (Q17=1)… IF Q5a=1: In general, I feel the skills I am learning in the program will improve my potential for promotion or better position. IF Q5=1 or Q5a=2: In general, I feel the skills I learned in the program will improve my potential for promotion or a better position.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
Career Counseling		IFQ5a=1: While in the program, have you started a job search? IFQ5=1 or Q5a=2: Did you start a job search while you were still in the program?	Yes (GO TO Q42) No (SKIP TO Q44)
		Did you use your school’s career-counseling services to help you with this job search?	Yes (GO TO Q43) No (SKIP TO Q44) Career counseling was not available (SKIP TO Q44)
		To what extent do you agree with the following statement? My school offered valuable career-counseling services.	Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree
Competency Exam		Do you plan on taking Competency Exam? [BRIEF DESCRIPTION TO BE ADDED AT A LATER DATE]	Yes (SKIP TO Q46) No (GO TO Q45)
		Why are you not planning to take the Competency Exam?	OPEN-ENDED
		Have you taken any other competency or certification exams?	Yes (GO TO Q47) No (SKIP TO Q48)
		Which exam(s)?	OPEN-ENDED (SKIP TO Q48)
		Do you plan on taking any other competency or certification exams?	Yes (GO TO Q49) No (SKIP TO Q50)
		Which exam?	OPEN-ENDED
Overall Feedback on the Program		What has been the best aspect of the program?	OPEN-ENDED
		What would you like to see improved in the program?	OPEN-ENDED
Demographics		Are you…	Male Female
		Are you of Hispanic, Latino, or Spanish origin? (Select all that apply.)	No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano Yes, Puerto Rican Yes, Cuban Yes, another Hispanic, Latino, or Spanish origin – Print Origin, for example Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. IF 5: Please specify the origin. OPEN-ENDED
		What is your race? (Select all that apply.)	White Black, African American American Indian, Alaska Native, Native American Asian Some other race IF 5: Please specify your race. OPEN-ENDED
Salary information and Financial Support		IF CURRENTLY WORKING (Q16≠4,5)… During a typical week, how much do you earn before deductions? If you hold more than one job, please report your earnings for your primary job. Your best estimate is fine.	Less than $200 $200-$399 $400-$599 $600-$799 $800-$999 $1,000-$1,199 $1,200-$1,399 $1,400 or more I’d prefer not to say.
		IF Q5a=1: Which of the following are sources of financial support for your program enrollment? (Select all that apply.) IF Q5=1 or Q5a=2: Which of the following were sources of financial support for your program enrollment? (Select all that apply.)	Fellowship, scholarship Government grant Other grant Internship/traineeship Student loan Private loan Personal earnings and, or savings Employer reimbursement/assistance Other – GO TO SPECIFY PROBE IF 10, SPECIFY PROBE: Please list your other sources of financial support for the program. OPEN-ENDED
	56a.	IF MORE THAN ONE SELECTED IN Q53... IF Q5a=1: Which source just mentioned provides the most support? (Select only one.) IF Q5=1 or Q5a=2: Which source just mentioned provided the most support? (Select only one.)	LIST ONLY THOSE CHOSEN IN Q56 AND IF 10, THE VERBATIM TEXT. Fellowship, scholarship Government grant Other grant Internship/traineeship Student loan Private loan Personal earnings and, or savings Spouse’s, partner’s, or family’s earnings or savings Employer reimbursement/assistance Other
Future contacting information		Because we are interested in how your education and employment experiences progress over time, we would like to contact you again to complete another brief survey next year. Once again, please note that your responses and any contact information you provide will be kept completely confidential and will not be shared with your school or program. Please provide the best contact information for reaching you in the future:	EMAIL, and reenter EMAIL TELEPHONE NUMBER TELEPHONE NUMBER TYPE – Home, Work, Cell MAILING ADDRESS
		In case we are unable to reach you, please provide the name and contact information of someone who would know how to reach you:	CONTACT NAME CONTACT RELATIONSHIP – Parent, Sibling, Other relative, Friend, Co-worker TELEPHONE NUMBER TELEPHONE NUMBER TYPE – Home, Work, Cell EMAIL MAILING ADDRESS
Thank you		Thank you very much for your participation.