Form Survey MQ712 Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

MQ712_Maintaining_your_Identity_as_a_Globally_Mobile_EFMMOH survey

MQ712 Survey

OMB: 1405-0193

Document [pdf]
Download: pdf | pdf
MQ712 Maintaining your Identity as a
Globally Mobile EFM/MOH
Survey Flow
EmbeddedData
Evaluation Survey Title = MQ712: Maintaining your Identity as a Globally Mobile
EFM/MOH
Evaluation Survey Course Date = [Insert Date of Course Here in MM/DD/YYYY Format]
Evaluation Survey Delivery Method = Virtual/In-Person/Hybrid
Standard: Survey Intro (2 Questions)
Standard: Evaluation Core Questions (2 Questions)
Standard: Division-Specific Questions (4 Questions)
Standard: Demographic Questions (4 Questions)
Page Break

Page 1 of 9

Start of Block: Survey Intro

Maintaining your Identity as a Globally Mobile EFM/MOH Evaluation Survey
Thank you for taking the time to complete the Maintaining your Identity as a Globally Mobile
EFM/MOH Evaluation Survey for the session on [Date].
Your feedback will help us improve our content and delivery for future instances of Maintaining
your Identity as a Globally Mobile EFM/MOH. Your responses will be kept confidential.
The survey should take no more than 5 minutes to complete.

PRA hold
If this course has more than 10 non-government employees enrolled in your course per year
then a PRA-approved survey message will need to be included here.
The verbiage will be provided to you after the survey has been approved by the GIS/DIR office
and should replace this message. If this is not applicable, this block of text can be removed.
End of Block: Survey Intro
Start of Block: Evaluation Core Questions

Page 2 of 9

Please indicate your level of agreement with the following statement:
Neither agree
Strongly
Somewhat
Somewhat
nor disagree
disagree (1)
disagree (2)
agree (4)
(3)

Strongly
agree (5)

The
knowledge,
skills, and/or
attitudes I
have learned
in this course
will help me
be more
prepared (1)

o

o

o

o

o

I am
confident I
will be able to
apply what I
learned in
this course
(2)

o

o

o

o

o

This course
kept me
actively
engaged (3)

o

o

o

o

o

Please indicate how you would describe the quality of the course overall:

o Terrible (1)
o Poor (2)
o Average (3)
o Good (4)
o Excellent (5)
End of Block: Evaluation Core Questions
Start of Block: Division-Specific Questions

Page 3 of 9

The following objectives were clearly identified:
Strongly
disagree (1)

Somewhat
disagree (2)

Neither agree
nor disagree
(3)

Somewhat
agree (4)

Strongly
agree (5)

Identify factors
that make the
Eligible Family
Member
(EFM)/Member
of Household
(MOH)
experience
unique. (1)

o

o

o

o

o

Explore
strategies to
assist with
navigating
ever-changing
circumstances
within the
Foreign
Service
lifestyle. (2)

o

o

o

o

o

Page 4 of 9

The following objectives were achieved:
Strongly
disagree (1)

Somewhat
disagree (2)

Neither agree
nor disagree
(3)

Somewhat
agree (4)

Strongly
agree (5)

Identify factors
that make the
Eligible Family
Member
(EFM)/Member
of Household
(MOH)
experience
unique. (1)

o

o

o

o

o

Explore
strategies to
assist with
navigating
ever-changing
circumstances
within the
Foreign
Service
lifestyle. (2)

o

o

o

o

o

Page Break

Page 5 of 9

What did you like about this course or find most helpful about this course?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

General comments/suggestions for improving this course:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
End of Block: Division-Specific Questions
Start of Block: Demographic Questions

Page 6 of 9

Are you affiliated with:

o Department of State (1)
o U.S. Agency for International Development (USAID) (2)
o Department of Agriculture (USDA) (3)
o Department of Commerce (4)
o Department of Defense (DOD) (5)
o Centers for Disease Control (CDC) (7)
o Drug Enforcement Administration (DEA) (8)
o Department of Justice (DOJ) (9)
o Federal Bureau of Investigation (FBI) (10)
o Department of Homeland Security (11)
o Peace Corps (12)
o Other: (6) __________________________________________________

Page 7 of 9

Which best describes you?

▢
▢
▢
▢
▢
▢
▢
▢
▢
▢

Foreign Service Generalist (DOS) (1)
Foreign Service Specialist (DOS) (2)
Foreign Service (Other Agency) (3)
Civil Service (9)
Eligible Family Member (4)
Member of Household (5)
Contractor / Personal Service Contractor (6)
Re-employed Annuitant / When Actually Employed (11)
Locally Employed Staff / Foreign Service National (7)

Other (please specify): (8)
__________________________________________________

Page Break

Page 8 of 9

Current Grade Level:

o SFS, SES, SL, or equivalent (1)
o FS-01, GS-15, or equivalent (2)
o FS-02 to 03, GS-13 to 14, FSN-12, or equivalent (3)
o FS-04 to 06, GS-09 to 12, FSN-08 to 11, or equivalent (4)
o FS-07 to 09, GS-05 to 08, FSN-05 to 07, or equivalent (5)
o GS-04 or lower, FSN-04 or lower (6)
o Not applicable (Contractor, EFM, or Other) (7)
How many years have you been affiliated with your agency as a direct hire, contractor,
and/or family member?

o 0 - 5 (1)
o 6 - 10 (2)
o 11 - 15 (3)
o 16+ (4)
End of Block: Demographic Questions

Page 9 of 9


File Typeapplication/pdf
File TitleMQ712 Maintaining your Identity as a Globally Mobile EFM/MOH
AuthorQualtrics
File Modified2024-02-23
File Created2024-02-23

© 2024 OMB.report | Privacy Policy