Requester Feedback Form

OMB Control Number: 0970-0519
Expiration Date: 10/31/2021

REQUESTER
FEEDBACK
Form

In order to help the National Human Trafficking Training and Technical Assistance Center (NHTTAC) better serve the field, we
are reaching out to obtain your feedback. We will protect the privacy of your information in accordance with the Federal Privacy
Act, and we will protect the confidentiality of your responses using procedures we have in place, including reporting all
information in aggregate to avoid identifying information. Only members of the NHTTAC Evaluation Team have access to
information that could identify respondents. If you have any questions about this survey or the evaluation, please contact
NHTTACEval@icf.com.
REQUESTER NAME/AGENCY:
CONSULTANT(S)/PRESENTER(S):
NHTTAC TRAINING/TECHNICAL ASSISTANCE SPECIALIST: ________________________________________________________

1.

Please select the type of training and technical assistance (T/TA) you requested:


Needs assessment



Review of materials (e.g., protocols, screening
forms, etc.)



Organization audit



SOAR for communities



Remote training



In-person SOAR training



Training of trainers



In-person training



SOAR training for HHS personnel



Peer-to-peer collaboration



Strategic partnerships for SOAR Online



Coaching



Other (please specify): ___________



Mentorship

Please indicate the extent to which you were satisfied or not satisfied with your overall experience working with NHTTAC:

2.

Very
Dissatisfied

Dissatisfied

Satisfied

Very
Satisfied

1

2

3

4

1

2

3

4

3.

The overall quality of the support you received from NHTTAC
staff
Your overall experience with NHTTAC staff

4.

Your interactions with NHTTAC staff

1

2

3

4

5.

Your interactions with the consultants

1

2

3

4

6.

The quality of support you received from NHTTAC staff during the
needs assessment process
The quality of support you received from the consultants in
implementing the T/TA

1

2

3

4

1

2

3

4

7.

Please indicate the extent to which you agree or disagree with the following statements about your interactions with NHTTAC
staff and the planning process:

PLANNING
8.
9.

NHTTAC was responsive to my questions and needs.
NHTTAC was effective in identifying an appropriate
consultant/presenter.
10. NHTTAC staff was detail oriented and thorough in the planning of
this T/TA.

Strongly
Disagree

Disagree

Agree

Strongly
Agree

1

2

3

4

1

2

3

4

1

2

3

4

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 7 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.

OMB Control Number: 0970-0519
Expiration Date: 10/31/2021

REQUESTER
FEEDBACK
Form

11. NHTTAC was timely throughout the planning process.

1

2

3

4

Strongly
Disagree

Disagree

Agree

Strongly
Agree

1

2

3

4

1

2

3

4

1

2

3

4

15. As a result of the needs assessment, [I][my organization] can….

1

2

3

4

16. As a result of the needs assessment, [I][my organization] can….

1

2

3

4

17. As a result of the needs assessment, [I][my organization] can….

1

2

3

4

NEEDS ASSESSMENT
12. NHTTAC helped me determine the most important needs are for
[me][my organization] to address human trafficking.
13. NHTTAC helped me determine the most important needs are for
[me][my organization] to .
14. NHTTAC helped me determine the most important needs are for
[me][my organization] to .

18. What aspects of the NHTTAC planning process were most helpful, and why?

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
19. What aspects of the needs assessment were most helpful, and why?

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Please indicate the extent to which you agree or disagree with the following statements about the consultants:

CONSULTANT 1:_____________________

Strongly
Disagree

Disagree

Agree

Strongly
Agree

20. The consultant was easy to communicate with in planning for the T/TA.

1

2

3

4

21. The consultant responded to me in a timely manner.

1

2

3

4

22. The consultant was respectful.

1

2

3

4

23. The consultant’s knowledge and expertise were appropriate for my needs.

1

2

3

4

Strongly
Disagree

Disagree

Agree

Strongly
Agree

24. The consultant was easy to communicate with in planning for the T/TA.

1

2

3

4

25. The consultant responded to me in a timely manner.

1

2

3

4

26. The consultant was respectful.

1

2

3

4

27. The consultant’s knowledge and expertise were appropriate for my needs.

1

2

3

4

CONSULTANT 2:_____________________

28. Would you recommend [NHTTAC][SOAR] T/TA to others to receive T/TA?

□ Yes

□ No

29. What suggestions do you have for improving NHTTAC’s support of T/TA planning and/or delivery?

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 7 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.

OMB Control Number: 0970-0519
Expiration Date: 10/31/2021

REQUESTER
FEEDBACK
Form

30. What additional needs do you or your organization have regarding this topic?

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
31. Which of the following best describes the organization in which you work? (Mark all that apply.)
 Academic institution
 OTIP grantee
 Anti-trafficking organization
 Self-employed
 Business/For-profit organization
 Survivor-led organization
 Coalition/Multidisciplinary team/Task force
 Tribal government
 Federal government
 Union/Worker advocacy organization
 Faith-based organization
 Victim service provider
 State and local government
 Other (please specify): _____________________
 Nonprofit/Community-based organization
32. Is your organization responsible for working with people who are currently being trafficked or have been trafficked?
□ Yes
□ No
33. Which of the following best describes your professional capacity or types of services you provide? (Mark all that apply.)











Behavioral health professional (e.g., psychologist,
psychiatrist, mental health/substance use counselor)
Child welfare (e.g., state agency staff, child welfare
contractor, nonprofit personnel)
Corrections-based services (e.g., parole, probation)
Criminal justice (e.g., law enforcement, prosecutor,
probation, court, forensic interviewer)
Educator (e.g., teacher, professor, school
administrator)
Health care (e.g., physician, physician assistant,
nurse practitioner, dentist, nurse, pharmacist)
Housing (e.g., case worker, shelter director, public
housing authority agencies)








Legal (e.g., immigration, civil and/or rights-based
attorney and/or paralegal, clinic)
Public health (e.g., licensure board, health
department staff, health care executive, community
health workers)
Social worker (e.g., case manager, school
counselor, supervisor, administrator)
Survivor empowerment, mentoring, or peer to peer
Violence prevention (e.g., child abuse and neglect,
elder abuse, domestic violence, sexual violence,
youth violence)
Other (please specify):
_______________________________

34. In your professional capacity, how frequently do you come into contact with a person who is currently being trafficked, at
risk of being trafficked, or has been trafficked?
1

2

3

4

Never

Occasionally

Frequently

Daily

35. Which of the following best describes the number of years of experience you have in your current field of work?
□

Less than 3 years

□

3–5 years

□

□

6–10 years

More than 10 years

36. Which of the following best describes your primary role in your current position?
□

Direct delivery/Frontline staff

□

Consultant/Trainer

□

Administration

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 7 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.

OMB Control Number: 0970-0519
Expiration Date: 10/31/2021

REQUESTER
FEEDBACK
Form
□
□

Management
□
Other (please specify): _______________

□

Volunteer

Peer Educator

37. Which of the following best describes your geographic population? (Mark all that apply.)
□

National

□

State (please specify): ______________
□ Tribal
□ International (please specify country):
_________________________________

□

Local
□
□
□

Urban
Rural
Suburban

38. Please select any of the following populations you currently work with in a professional capacity. (Mark all that apply.)









Human trafficking
 Commercial sexual exploitation of
children
 Sex trafficking
 Adults
 Minors
 Labor trafficking
 Adults
 Minors
Children/youth
 Out of home/Foster care/Kinship care
 Juvenile justice
 Runaway/Homeless youth
People with disabilities
Deaf/Hearing impaired
Elderly
Lesbian, gay, bisexual, transgender, and
questioning












Foreign nationals (migrant workers, undocumented
immigrants, refugees)
People with low incomes
Racial and ethnic minorities
 American Indian or Alaska Native
 Asian
 Black or African American
 Native Hawaii or other Pacific Islander
 White
 Hispanic or Latino ethnicity
History of substance use
Intimate partner violence (e.g., dating, domestic
violence)
Gang-related crime
Sexual abuse/Violence
Other (please specify): __________________

39. Do you have any other comments or suggestions you would like to share about your [NHTTAC][SOAR] experience?

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Thank you for taking the time to complete this form and helping to improve NHTTAC activities.

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 7 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.