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Assessment Services - Requester Questionnaire
OMB Number: 3320-0003
Approval Expiry Date: 02/28/2015
The U.S. Institute for Environmental Conflict Resolution (U.S. Institute) evaluates all of its services. As a part of this
evaluation we ask the agency representatives who have requested U.S. Institute services to provide us with
information about their experience. Your responses will be used to improve our programs and services. The
average estimated reporting burden for this questionnaire is 5 minutes.

Base Survey: Assessment Services - Requester Questionnaire
1. What prompted the request for consultation and upfront assessment services from the U.S.
Institute?

Base Survey: Assessment Services - Requester Questionnaire
2. Briefly describe the services the U.S Institute provided?

Base Survey: Assessment Services - Requester Questionnaire
3. Using the scale below, please rate your agreement with the following statement:

3a. The U.S. Institute’s services (including the contractor services, if applicable) helped us
determine how best to proceed to solve this problem/resolve this conflict.
0 - Do not agree at all

5 - Moderately agree

10 - Completely agree

Base Survey: Assessment Services - Requester Questionnaire
4. Using the scale provided, please rate the extent to which you agree with the following
statements about the consultation and assessment services provided by the U.S. Institute
(including the work conducted by the contracted practitioner).:

4a. Key issues were explored.
0 - Do not agree at all

5 - Moderately agree

10 - Completely agree

4b. Key issues were considered in the recommendations on how to proceed.
0 - Do not agree at all

5 - Moderately agree

10 - Completely agree

4c. Input was sought from key parties to the situation/controversy.
0 - Do not agree at all

5 - Moderately agree

10 - Completely agree

4d. I would use a situation/conflict assessment again for similar situations.
0 - Do not agree at all

5 - Moderately agree

10 - Completely agree

Base Survey: Assessment Services - Requester Questionnaire
5. Please indicate your overall level of satisfaction with the U.S. Institute’s services:
Totally Dissatisfied
Mostly Dissatisfied
Somewhat Dissatisfied
Neither Satisfied nor Dissatisfied
Somewhat Satisfied
Mostly Satisfied
Totally Satisfied

Please elaborate:

Base Survey: Assessment Services - Requester Questionnaire
6. What are the anticipated benefits/impacts of the U.S. Institute’s services?

Base Survey: Assessment Services - Requester Questionnaire
7. If your work with the U.S. Institute were starting over again, what changes would you like
to see happen?

Base Survey: Assessment Services - Requester Questionnaire
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS QUESTIONNAIRE.