Form 3 Exit Survey Part 2 Feedback Survey

Attachment 2b –Exit Survey Part 2 Feedback Screenshots
* Black boxes in screenshots indicate the person’s name that has been blacked out

1. The 1st page of the “Exit Survey Part 2: Assess your Experience” displays which includes the OMB
Statement at the top of the page:

1

2. The 2nd page of the Part 2 Survey displays when the Trainee clicks the “Next” button on the 1st page:

2

3. The 3rd page of the Part 2 Survey displays when the Trainee clicks the “Next” button on the 2nd page:

3

4

4. The 4th page of the Part 2 Survey displays when the Trainee clicks the “Next” button on the 3rd page:

5. The “Decline to Answer” popup is displayed when Trainee clicks the “Decline To Answer” button at
the bottom of the Part 2 Survey’s 4th page. The trainee may choose to return to Part 2 of the Survey or
exit Part 2.
5

6. Trainee clicks the “Submit” button to submit the Part 2 Survey. The “Thank You” page appears after
the successful Part 2 submission.

6