Form 3320-0005(1) Roster Services - Searcher Questionnaire (Rev 2012)

OMB Number: 3320-0005
Approval Expiry Date:

Referral Evaluation
The U.S. Institute for Environmental Conflict Resolution evaluates all of its projects and cases. The U.S.
Institute requests your assistance with the evaluation of the Roster Program. Your responses will be used
to improve our programs and services. The average estimated reporting burden for this questionnaire is 4
minutes. This estimate includes time for reviewing the instructions and completing the questionnaire.
Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the U.S. Institute. Information from this evaluation will
not be reported in a way that individuals or organizations can be identified. The Office of Management
and Budget control number that is displayed on the cover is currently valid and authorizes this collection
of information.

1. Please indicate your primary reason for conducting this roster search.
Check
only one


0

a. Searching for appropriate practitioners to assist in solving problems or
resolving disputes involving environmental, natural resource, or public
lands issues.



b. Searching for other practitioner(s) with whom to partner or team.
(SKIP 2 AND GO TO 3)



c. Other, please specify: __________________________________
(SKIP 2 AND GO TO 3)

1

Do not agree
at all

2

3

4

5
Moderately
agree

6

7

8

9

10
Completely
agree

2. Using the scale above, please rate the extent to which you agree with the following
statements about the roster.
Ratings

_____

a. In general, I feel the roster system expedites the process of finding an
appropriate practitioner for a user like me.

_____

b. Using the roster system gives me confidence that my short list includes a
sufficient array of appropriate practitioners.
c. I would recommend the roster system to others looking for environmental
conflict resolution practitioners.

_____

0

1

2

Do not agree
at all

3

4

5
Moderately
agree

6

7

8

9

10
Completely
agree

3. Using the scale above, please rate the extent to which you agree with the following
statement.
Ratings

_____

The roster system is a valuable resource.

Please elaborate:
_________________________________________________________________
_________________________________________________________________

4. Do you have any additional comments that you would like to provide (e.g.,
comments on how the roster system could be improved to better serve your needs)?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Thank you for taking the time to complete this questionnaire.
PERSONS WITH DISABILITIES WHO REQUIRE ALTERNATIVE MEANS FOR
COMMUNICATION OF PROGRAM EVALUATION INFORMATION SHOULD CONTACT
THE U.S. INSTITUTE AT (520) 901-8548.

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