6 Attachment F_Leadership Academy Session Survey

OMB No: 0915-0212

Expiration date: 04/30/2024

Leadership Academy (Session) Survey

Sent after each Leadership Academy Session

Public Burden Statement: The purpose of this information collection request is to assess participant satisfaction with various training and TA activities offered through a contracted TA provider, the Education Development Center. 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. This data collection is voluntary. The OMB control number for this project is 0915-0212 and is valid until 04/30/2024. Public reporting burden for this collection of information is estimated to average .08 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857.

1. How satisfied were you with today’s Leadership Academy session?

   1. Extremely satisfied

   2. Satisfied

   3. Dissatisfied

   4. Extremely dissatisfied

2. [If chosen “Dissatisfied” or “Extremely dissatisfied”] Please explain why you were dissatisfied with the session: [Open text]

3. What was the MOST helpful feature of today’s Leadership Academy session? [Open text]

4. What was the LEAST helpful feature of today’s Leadership Academy session? [Open text]

5. How can we improve future Leadership Academy sessions? [Open text]

6. We are particularly interested in whether today’s Leadership Academy was provided in a culturally appropriate manner. Please rate your agreement with the following statement: This Leadership Academy was provided in a culturally responsive manner (respectful of individual beliefs, language, perspectives, and needs).

1. Strongly agree

2. Agree

3. Neither agree nor disagree

4. Disagree

7. [If disagree] Please explain how we could improve our TA in being more culturally responsive: [Open text]