OMB Control No.: 0970-0484
Expiration Date: XX/XX/XXXX
THE
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting
burden for this collection of information is estimated to average 5
minutes per response, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the
collection of information. An agency may not conduct or sponsor, and
a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number.
Webinars, Events and In-Person Meetings survey
Instructions for On-line Survey Development
For each webinar or event hosted by the Collaborative, a survey will be created in on-line survey software to gather feedback that can inform project planning. Given the changing nature and context of each product and the content on each webpage, it is important to be able to get feedback from recipients without creating undue burden by answering excessive questions that only marginally apply. To address this, the survey will be tailored to the unique information needs of each event to ensure low burden while informing high quality service provision. When creating each on-line survey, content specialists will use the required questions listed below and choose up to 14 context specific optional questions that can be added to the survey, as needed. This will allow for unique information needs to be met.
It is expected that each tailored survey will have no more than 20 questions, including 11 required questions and a maximum of 7-9 optional questions, with a burden of no more than 5 minutes.
Required Questions (11 required)
|
Strongly Disagree |
2 |
3 |
Neither |
5 |
6 |
Strongly Agree |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
|
SD |
2 |
3 |
N |
5 |
6 |
SA |
What aspects of the [Name of Peer Networking Experience, Event, Webinar] were most useful for your work?
Were there ways in which the [Name of Peer Networking Activity, Event, or Webinar] could have been more useful to you? (Yes/No)
If yes, please describe how this [Name of Peer Networking Activity, Event, or Webinar] could have been more useful?
Which of the following best describes your position or role? (Check all that apply)
Administrative Leadership (director/deputies)
Training Department/Division
Supervisors
Case Workers/Direct Practices Workers
Data Managers & IT Staff
Foster Care Managers
Adoption Managers
Courts
CIP Coordinators
Judges
Attorneys
Court Administrative Officers
Attorney/Attorney-GALs
Court/Attorney Data Managers & IT staff
CASAs/Non-attorney GALs/other advocates
Case Workers/Social Workers/Other
Stakeholders
Contracted Service Providers (provide examples)
Law Enforcement
Health
Mental Health
Substance Abuse
Domestic Violence
Education
Community (provide examples)
Families, Parents, Youth (provide examples)
Foster Parent/Caregivers
Tribal child welfare
Tribal Council
Tribal Court
Tribal Elders
Other tribal program (Please describe)
In which State/Territory/Tribe do you work?___________
Please select the various ways you [insert have already applied the information, plan to apply the information] from the [Name of Peer Networking Activity, Event, or Webinar] in your work. (Check all that apply)
Support program improvement
Support policy development
Provide information to clients/families
Share with peers
Support public awareness/advocacy
Grant writing/Fundraising
Train staff/colleagues
Conduct research & evaluation
My own professional development (e.g., increased knowledge)
I have not yet applied this to my work
Other (Please describe):__________
You indicated that you plan to use this information to train others. In what setting will it be used?
Formal Training with Co-Workers
Informal Training with Co-Workers
Distribute Materials to Co-Workers
Classroom/University
Train the Trainer
Other
Please provide a specific example: ___________________________
Optional Questions (choose up to 6)
Rating Questions (7pt likert scale)
The content of the [Name of Peer Networking Activity, Event or Webinar] felt relevant to the values and context of my agency.
The content provided in the [Name of Peer Networking Activity, Event or Webinar] felt relevant to the values and context of the communities my agency serves.
The [Name of Peer Networking Activity, Event or Webinar] featured topics that are timely and current.
The technology enhanced the [Name of Peer Networking Activity, Event or Webinar].
Appropriate instructions were given on how to manage the technology used.
The time allotted was appropriate for meeting the [Name of Peer Networking Activity, Event or Webinar] goals.
I found the pre-session assignments and background materials to be helpful in preparing me for the [Name of Peer Networking Activity, Event or Webinar].
The format of the [Name of Peer Networking Activity, Event or Webinar] made it easy to participate.
I liked the format of this [Name of Peer Networking Activity, Event or Webinar].
The facilitator helped me interact with my peers in a meaningful way.
The knowledge and expertise of this trainer/presenter/consultant were appropriate for this [Name of Peer Networking Activity, Event or Webinar].
The trainer/presenter/consultant tailored and delivered the content of the [Name of Peer Networking Activity, Event or Webinar] effectively.
The trainer/facilitator helped me to see how the [Name of Peer Networking Activity, Event or Webinar] can be applied to my work.
The trainer/facilitator provided sufficient opportunities to practice new information/skills.
As a result of my participation, I am able to [Name of Peer Networking Activity, Event or Webinar goal 1]. (Insert/delete as many objectives/goals as necessary)
The [Name of Peer Networking Activity, Event or Webinar] has increased my knowledge about [Topic 1]. (Insert/delete as many topics as necessary)
The [Name of Peer Networking Activity, Event or Webinar] has increased my practical skills regarding [Topic 1]. (Insert/delete as many topics as necessary)
The [Name of Peer Networking Activity, Event or Webinar] has motivated me to continue learning in this topic area.
As a result of the [information I learned, knowledge I gained] through the [Name of Peer Networking Activity, Event or Webinar], I will be a more effective in my work.
The information provided [Name of Peer Networking Activity, Event or Webinar] helped me to understand the <insert topic>.
The information provided in [Name of Peer Networking Activity, Event or Webinar] helped me to understand the five capacity domains.
The [Name of Peer Networking Activity, Event or Webinar] had a good cultural fit for my tribal [agency, community, or work].
I would recommend that individuals from other tribal programs participate in [Name of Peer Networking Activity, Event or Webinar].
As a result of my involvement in the [Name of Peer Networking Activity, Event or Webinar], I have improved my connections with peers/colleagues.
The Name of Peer Networking Experience, Event, Webinar] has positively impacted my attitudes concerning the [Topic Area 1].
Open-ended questions:
Provide a specific example of how the [Name of Peer Networking Activity, Event or Webinar] has improved your relationship with peers or benefitted your work.
Was [Title of Activity 1] helpful? If so, why, and if not, how can they be improved?
Pick one or two appropriate training activities
What additional assistance do you or your organization need with this topic?
What additional information or resources can you recommend on this topic?
Do you have any additional comments?
Response choice questions:
How often do I anticipate (or am I) applying what was learned?
Daily
Weekly
Monthly
Quarterly
Annually
Never
As a result of this [Name of Peer Networking Activity, Event or Webinar], <how often, over the past six month do you anticipate engaging/have engaged with other attendees outside of official activities?
Never
Once
Every Few Months
Monthly
A Few Times a Month
Weekly
Two to Three Times a Week
I have discovered new tools, ideas, & ways of thinking from the relationships developed during the [Name of Learning Experience, Name of Peer Networking Activity]? < yes/no> Please explain
As a result of my participation/involvement in the [Name of Peer Networking Activity, Event or Webinar], I developed new relationships with …
[Insert options that are relevant to the target audience]
I am involved in the following aspect of the Center for States capacity building services:
Select all that apply:
State team working with liaison
Participating in constituency group
Registered for one of the Center’s learning
Learning Experiences (such as the CQI Training Academy, etc.)
I am involved in the following aspect of the Center for Tribes capacity building services:
Select all that apply:
Tribal team working with Center liaison
Participating in a constituency group
Registered for one of the Center’s learning experiences
Center for Tribes staff
Other (please describe) ___________________________
How did you learn about the [Name of Peer Networking Activity, Event or Webinar]? (Check all that apply)
Capacity Building Collaborative webpage
Center for States staff
Center for Tribes staff person
Listserv
Colleague
Hard-copy publication
Advertisement (please specify)
Search engine (e.g., Google, Yahoo)
Social media (e.g., Facebook, Twitter, YouTube)
Conference or presentation (please specify)
Link from another webpage (please specify)
Children’s Bureau
Other (please specify):__________
Which of the following best describes your workplace? (Check one)
State public agency
Local or county public agency/organization
Federal agency
Legislature
Non-profit (e.g. community-based organization, faith-based organization)
Tribal agency/organization
Training and technical assistance provider
Capacity Building Center for States
Capacity Building Center for Tribes
Capacity Building Center for Courts
Children’s Bureau
Other (Please describe)
Which of the following best describes your position? (Check one)
Administrative Leadership (directors/deputies)
Training Department
Supervisors
Case Workers/Direct Practice Workers
Data Mangers & IT staff
Court/Attorney Data Managers & IT Staff
Foster Care Managers
Adoption Mangers
Intern/Volunteer
Other (Please describe)
How many years of service do you have in your current profession? (Check one)
Less than 1 year
1–5 years of service
6–10 years of service
11–15 years of service
16+ years of service
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | CBC States Notes Template |
Author | Emily Manbeck |
File Modified | 0000-00-00 |
File Created | 2021-01-15 |