Mentor Survey

MENTOR SURVEY

#	Question	Response Options
	Dear {to be auto populated} Social Impact is working on behalf of the TechWomen Program, an initiative of the U.S. Department of State’s Bureau of Education and Cultural Affairs. Social Impact is not affiliated with IIE. The goal of this survey is to understand the relationships you have built as a result of your participation as a mentor in the TechWomen program. The survey will also ask questions about your life after participation in the program. Your participation in this survey is voluntary. Please take this survey on a computer or laptop, if possible. Completing this survey should take about 20-30 minutes. Thank you for your participation. *personalized link to survey* Please complete the survey by date. Thank you for your feedback! The Social Impact Evaluation Team ********************************************* ADDITIONAL EVALUATION INFORMATION What is the purpose of this evaluation? This evaluation is focused on reviewing the impact of the TechWomen program and strength and sustainability of professional networks created by the program. The Bureau of Educational and Cultural Affairs (ECA) at the U.S. Department of State commissioned Social Impact to conduct this evaluation. We are requesting your participation in this electronic survey because of you engaged with the TechWomen program as a mentor/impact coach. Your valuable experience will help us understand the program’s impact on you, other TechWomen alumnae, and your local community. Will my feedback be confidential? Yes! Keeping your identity and feedback confidential is very important to us. We will be developing a report as part of this evaluation. To protect respondents’ identities, we will aggregate survey feedback across responses and anonymize any quotes. Can I forward this survey to other Mentors/Impact Coaches? The link in this survey is unique to you. If you know of other Mentors/Impact Coaches in your network who have not received this survey, please reach out XX. If you have any questions or concerns, you may contact the Social Impact Institutional Review Board at irb@socialimpact.com or +1 703 465 1884 with questions about the study or results.

MODULE A: CONSENT

#	Question	Response Options	EQ
	Landing page text/Consent Script: Social Impact is working on behalf of the TechWomen Program, an initiative of the U.S. Department of State’s Bureau of Education and Cultural Affairs. The goal of this survey is to understand the relationships you have built as a result of your participation in the TechWomen program. The survey will also ask questions about your life after participation in the program. Please take this survey on a computer or laptop, if possible. Taking this survey should take approximately 20-30 minutes. There are no risks to participating in the survey, and there are no direct benefits, though your participation may benefit those who participate in future programs. Participating in this survey does not influence your ability to participate in future TechWomen programming. All the responses you provide during this survey will be kept confidential to the extent authorized by law . Only the researchers directly involved in this study will have access to your personal information. Your participation in this study is voluntary and you are under no obligation to participate. If you start the survey and wish to stop at any time for any reason, or if you do not want to answer any questions, you may do so without penalty. Please complete this survey by date. If you have any questions or concerns, you may contact the Social Impact Institutional Review Board at irb@socialimpact.com or +1 703 465 1884 with questions about the study or results. If you agree to participate, please click “Proceed to next step”	[1] Proceed to next step
b	Privacy Act Statement AUTHORITY: The information on this form is requested under the authority of 22 U.S.C. 2451 et seq (Mutual Educational and Cultural Exchange Act of 1961), P.L. 103-62 (Government Performance and Results Act of 1993), and P.L. 111-352 (Government Performance and Results Modernization Act of 2010). PURPOSE: The purpose of gathering this information is to track the networks and relationships built by mentors as a result of participation in the TechWomen program. ROUTINE USES: The information on this form may be shared with members of Congress, and the Office of Management and Budget (OMB). De-identified data files may be shared (without Personally Identifiable Information such as names or contact information) with ECA implementing partners and external researchers who are assisting ECA in measuring its impact. More information on the Routine Uses for the system can be found in the System of Records Notice State-08, Educational and Cultural Exchange Program Records. DISCLOSURE: Responding to this survey is voluntary. The answers you provide on the survey will have no bearing on your participation in future program activities or any future applications you may submit for U.S. State Department programs. By clicking “Consent and Enter Survey” button below, you are consenting to the above terms.	[1] Proceed to next step

MODULE B: DEMOGRAPHICS AND ATTRIBUTE QUESTIONS

#

Question

Response Options

EQ

What is your age in years?

25 – 34

35 – 44

45 – 54

55 – 64

65+

[-99] Prefer not to answer

B

Which gender best describes you?

[1] female
[2] male
[3] non-binary
[4] other
[-99] prefer not to say

B

In what year did you participate in the TechWomen program as a Mentor or Impact Coach

Select all that apply:

[1] drop down menu of years 2011-2019

B

Did you participate in a delegation trip? If so, which?

[1] no

[2] drop down menu of delegation trips

EQ3

Approximately how many TechWomen Alumnae have you mentored or coached? Please provide a number.

Text box for number

EQ3

Have you ever been a co-mentor in the TechWomen Program?

[1] yes

[2] no

EQ3

In which of the following professional tracks have you mentored TechWomen Alumnae:

Select all that apply:

[1] Internet
[2] Information technology
[3] Green technology/clean technology
[4] Science
[5] BioTechnology
[6] Software
[7] Telecommunications
[8] Hardware

P

Have you established or continued professional collaborations that resulted from your TechWomen experience? (check all that apply)

Select all that apply.

[1] Yes, with people in the United States
[2] Yes, with TechWomen participants
[3] Yes with people from other countries that I met in the program
[0] No

EQ3

Please reflect on your overall mentorship experience in the TechWomen program and answer the following questions.	Select from Scale 1 = Strongly Disagree to 7 = Strongly Agree
I enjoyed the experience of being a mentor	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree
I expected that being a mentor would be more fun than it actually is	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree
My mentee(s) and I are interested in the same things	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree
My mentee(s) and I are sometimes at a loss for things to talk about	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree
My mentee(s) made improvements after we started meeting	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree
I sometimes feel overwhelmed by my mentee(s)’ situational difficulties	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree
My mentee(s) and I have been well matched	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree
I feel close to my mentee(s)	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree
Being a mentor has been a more of a time commitment than I expected	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree

EQ3

MODULE C: NETWORK QUESTIONS ABOUT ALUMNAE

#

Question

Response Options

EQ

From the list below, identify any TechWomen Alumnae whom you have mentored, provided advice, or information.

Selects names from roster of alumnae

EQ3

[answers for each person selected in c1]

How frequently do you communicate with this person?

Select from drop down menu

[0] never
[1] about once a year
[2] several times a year
[3] about once a month
[4] several times a month
[5] once or twice a week
[6] almost every day

EQ3

How close would you describe your relationship with this person?

[1] Slider scale, 1 = Not very close, 4 = reasonably close to 7 = Very close

EQ3

The mentoring relationship between this mentee and I was very effective.	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree
I am very satisfied with the mentoring relationship this mentee and I developed.	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree
Both this mentee and I benefited from the mentoring relationship.	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree
I was effectively utilized as a mentor by this mentee.	[1] Slider scale, 1 = Strongly Disagree to 7 = Strongly Agree

MODULE D: NETWORK QUESTIONS ABOUT COLLABORATIONS

#	Question	Response Options	EQ
	From the list below, identify any TechWomen Alumnae with whom you have collaborated on a mutual project.	Selects names from roster of Alumnae	EQ3
	[answers for each person selected in 1] How frequently do you communicate with this person?	Select from drop down menu [0] never [1] about once a year [2] several times a year [3] about once a month [4] several times a month [5] once or twice a week [6] almost every day	EQ3
	[answers for each person selected in 1] How close would you describe your relationship with this person?	[1] Slider scale, 1 = Not very close, 4 = reasonably close to 7 = Very close	EQ3
	How effective is this relationship in terms of producing desired results?	Slider scale, 1 = not very effective to 7 = very effective.

MODULE E: NETWORK QUESTIONS ABOUT MENTOR RELATIONSHIPS

#	Question	Response Options	EQ
1.	From the list below, please select any other TechWomen mentors or coaches with whom you have maintained a professional or personal relationship.	Selects names from roster	EQ3
2.	[answers for each person selected in 1] How frequently do you communicate with this person?	Select from drop down menu [0] never [1] about once a year [2] several times a year [3] about once a month [4] several times a month [5] once or twice a week [6] almost every day	EQ3
3.	[answers for each person selected in 1] How close would you describe your relationship with this person?	Slider scale, 1 = Not very close, 4 = reasonably close to 7 = Very close	EQ3
4.	[answers for each person selected in 1] Would you describe this relationship as personal, professional, or both?	[1) personal [2] professional [3] both [-99] rather not say	EQ3
5.	[answers for each person selected in 1] Have you collaborated on any mutual projects?	[1] no [2] yes	EQ3
	If yes, how effective has this collaboration been in terms of producing desired results?	Sliding scale from 1 = not very effective to 7 = very effective.

MODULE F: question about KII

#	Question	Response Options
1.	Are you interested in participating in an interview to discuss your experience as a mentor with the TechWomen program?	[1] yes [2} no
	Please provide the best way to contact you:	Email: Phone/WhatsApp:

MODULE G: END

#	Question	Response Options
	Many thanks for completing the survey. Your response has been recorded and you can close the browser window. If you would like to change your responses just click on the email which included a link to this survey.

OMB Control Number: 1405-XXXX Burden Estimate:  30 minutes Expiration Date: XX-XX-XXXX

PRA Statement Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection.  You do not have to supply this information unless this collection displays a currently valid OMB control number.  If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: ecaevaluation@state.gov.