Video Action Kit Survey

Not In Our Town/DOJ COPS Office Film Evaluation

NIOT Video Action Kit

Please answer the following questions based on your recent download of the NIOT/COPS Video Action Kit. Thank you for your participation.

1) How would you rate the following in reference to this website?

	5 Excellent	4 Good	3 OK	2 Fair	1 Poor
a. Usefulness of information presented
b. Usefulness of resources presented
c. Usefulness in developing and presenting community discussions
d. Overall impact of the Video Action Kit

2) Has this Video Action Kit provided any of the following?

	Yes, very much	Yes, somewhat	No, didn’t make a difference	Not applicable
a. Information or tools you can use in your work
b. Increased motivation to prevent hate, intolerance, and/or bullying in your community
c. Deeper understanding why hate crimes need to be reported, investigated, and prosecuted
d. Increased motivation to improve or address hate crime reporting in your agency, organization and/or community
e. New ideas and resources for building relationships between diverse groups, agencies, and organizations within your community
f. Deeper understanding of how to serve hate crime victims

3) What opportunities and/or challenges do you anticipate in using the new resources from this website within your community or agency?

4) What additional information and/or supplemental resources would you like to see presented in the future to support your work?

5) Additional comments?

6) Demographic Information

We request the following information to help us understand and better serve our audience. Thank you.

a. Gender ☐Male ☐Female ☐ Other

b. Age ☐12 or younger ☐13-18 ☐19-25 ☐26-35 ☐36-45 ☐46-55

☐56-65 ☐66+

c. Ethnicity ☐Hispanic or Latino

☐ Not Hispanic or Latino

d. Race ☐American Indian or Alaska Native ☐Asian ☐Black or African American ☐Native Hawaiian or Other Pacific Islander ☐White

e. Constituency ☐Law enforcement ☐Student ☐Educator ☐Community member

☐Civic leader ☐Faith group member ☐Other__________________

f. Occupation

Would you like to get more resources or updates from Not In Our Town?

If yes, please provide: Name ________________________________________________

Phone ________________ Email ___________________________

Thank you for your participation!

For more information on how to prevent hate, intolerance, and bullying in your community, please visit the Not In Our Town website at www.niot.org.

The public reporting burden for this collection of information is estimated to be up to 5 minutes per response. Send comments regarding this burden estimate or any other aspects of the collection of this information, including suggestions for reducing this burden, to the Office of Community Oriented Policing Services, U.S. Department of Justice, 145 N Street, N.E., Washington, DC 20530; and to the Public Use Reports Project, Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.

You are not required to respond to this collection of information unless it displays a valid OMB control number. The OMB control number for this application is XXXX-XXXX and the expiration date is <insert date>.