Pilot Feedback Form

PILOT FEEDBACK

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

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.
TRAINING:
DATE(S):
CONSULTANT(S)/PRESENTER(S):

Please provide the information below to create an anonymous ID:

Birth Month

First letter of first name

First letter of your middle name

(insert just the month

(example: S for Sara)

(example: M for Maria)

for your date of birth:
08 for August)
Please indicate the extent to which you agree or disagree with the following statements:

OVERALL TRAINING
1.
2.

The training addressed the learning objectives clearly.
The training addressed the critical issues related to the
topic(s).
3. The time allotted was adequate for the scope of material
covered.
4. The training was well organized and clear.
5. The [material] [strategic planning] was appropriate for my
level of experience and knowledge.
6. The resource materials (handouts, audiovisuals,
PowerPoints) enhanced the training.
7. The training increased my knowledge related to the topic(s).
8. The training increased my practical skills related to the
topic(s).
9. I will be able to apply what I learned in my work.
10. The training improved my ability to identify people who are
being trafficked, at-risk of trafficking, or have been
trafficked.
11. The training was survivor informed.
12. The training provided sufficient opportunity to network with
others in the field.

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.15 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.

PILOT FEEDBACK

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

Form
13. The training was trauma informed.
14. The training content was based on current evidence-based
research or promising practices.
15. The small group activities enhanced my experience.
16. The training met my professional needs.
17. The training met my educational needs.
18. I am satisfied with the overall quality of the training.
19. The training was grounded in a multidisciplinary approach to
addressing human trafficking.

1

2

3

4

NA

1

2

3

4

NA

1
1
1
1

2
2
2
2

3
3
3
3

4
4
4
4

NA
NA
NA
NA

1

2

3

4

NA

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

MODULE :

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not Applicable

1
1
1
1
1

2
2
2
2
2

3
3
3
3
3

4
4
4
4
4

NA
NA
NA
NA
NA

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not Applicable

1
1
1
1
1

2
2
2
2
2

3
3
3
3
3

4
4
4
4
4

NA
NA
NA
NA
NA

20. As a result of this module, I can .
21. As a result of this module, I can .
22. As a result of this module, I can .
23. As a result of this module, I can .
24. The learning objectives for this module were stated clearly.

MODULE :
25. As a result of this module, I can .
26. As a result of this module, I can .
27. As a result of this module, I can .
28. As a result of this module, I can .
29. The learning objectives for this module were stated clearly.
30. Please rate the overall quality of this training.
1

2

3

4

Poor

Fair

Good

Excellent

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

PRESENTER 1:
31. The presenter demonstrated a comprehensive knowledge of
the subject.
32. The presenter presented the content clearly and logically.
33. The presenter responded positively to questions and
comments.
34. The presenter created a respectful environment for
participants.

PRESENTER 2:
35. The presenter demonstrated a comprehensive knowledge of
the subject.

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

1

2

3

4

NA

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.15 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.

PILOT FEEDBACK

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

Form
36. The presenter presented the content clearly and logically.
37. The presenter responded positively to questions and
comments.
38. The presenter created a respectful environment for
participants.

1

2

3

4

NA

1

2

3

4

NA

1

2

3

4

NA

39. Did the training provide comprehensive coverage of the topic(s)? Please explain.

40. Was the content current and up-to-date? Please explain.

41. Was there anything you would change about the training content? Please explain.

42. Was there anything you would change about the resource materials (videos, handouts, PowerPoints, etc.)? Please explain.

43. Was there enough time for discussion and questions? Please explain.

44. What aspects of the training were most helpful, and why?

45. Is there any material, content, or activity you would recommend to not include in future trainings?

46. Are there specific resources you would recommend for inclusion in future trainings?

47. Do you have any other comments or suggestions?

48. Which of the following best describes the organization in which you work? (Mark all that apply.)Academic institution
ϒ Nonprofit/Community-based organization
ϒ Anti-trafficking organization
ϒ OTIP grantee
ϒ Business/For-profit organization
ϒ
Self-employed
ϒ Coalition/Multidisciplinary team/Task force
ϒ
Survivor-led
organization
ϒ Federal government
ϒ
Tribal
government
ϒ Faith-based organization
ϒ State and local government
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.15 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.

PILOT FEEDBACK

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

Form
ϒ
ϒ

ϒ

Union/Worker advocacy organization
Victim service provider

Other (please specify):

49. Is your organization responsible for working with people who are currently being trafficked or have been trafficked?
□ Yes
□ No
50. Which of the following best describes your professional capacity or types of services you provide? (Mark all that apply.)
ϒ Legal (e.g., immigration, civil and/or rights-based
ϒ Behavioral health professional (e.g., psychologist,
attorney and/or paralegal, clinic)
psychiatrist, mental health/substance use counselor)
ϒ Public health (e.g., licensure board, health
ϒ Child welfare (e.g., state agency staff, child welfare
department staff, health care executive, community
contractor, nonprofit personnel)
health workers)
ϒ Corrections-based services (e.g., parole, probation)
ϒ Social worker (e.g., case manager, school
ϒ Criminal justice (e.g., law enforcement, prosecutor,
counselor, supervisor, administrator)
probation, court, forensic interviewer)
ϒ Survivor empowerment, mentoring, or peer to peer
ϒ Educator (e.g., teacher, professor, school
administrator)
ϒ Violence prevention (e.g., child abuse and neglect,
elder abuse, domestic violence, sexual violence,
ϒ Health care (e.g., physician, physician assistant,
youth violence)
nurse practitioner, dentist, nurse, pharmacist)
ϒ Other (please specify):
ϒ Housing (e.g., case worker, shelter director, public
housing authority agencies)
51. In your professional capacity, how frequently do you come into contact with a person who is being trafficked, at risk of
being trafficked, or has been trafficked?
1

2

3

4

Never

Occasionally

Frequently

Daily

52. 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

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

Direct delivery/Frontline staff
Management
Other (please specify):

□
□

Consultant/Trainer
Volunteer

□
□

Administration
Peer educator

54. 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

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.15 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.

PILOT FEEDBACK

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

Form

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

ϒ

ϒ
ϒ
ϒ

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

ϒ
ϒ
ϒ

ϒ
ϒ
ϒ
ϒ
ϒ

Foreign nationals (migrant workers, undocumented
immigrants, refugees)
People with low incomes
Racial and ethnic minorities
ϒ American Indian or Alaska Native
ϒ Asian
ϒ Black or African American
ϒ Native Hawaii or other Pacific Islander
ϒ White
ϒ 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):

56. What is your race? (Mark all that apply.)
□
□
□
□
□
□

American Indian or Alaska Native
Asian
Black or African American
Native Hawaii or other Pacific Islander
White
Other (please specify):

57. What is your ethnicity? (Mark all that apply.)
□
□
□

Hispanic or Latino
Middle Eastern or North African
Other (please specify):

58. What is your gender? (Mark all that apply.)
□
□
□
□

Male
Female
Transgender
Other (please specify):

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

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.15 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.