3320-0003 (A) Assessment Evaluation

OMB Number: 3320-0003
Agency Tracking Number: 0003A

National Center for Environmental Conflict Resolution
Assessment Evaluation – Requester Questionnaire
The John S. McCain III National Center for Environmental Conflict Resolution (National Center) evaluates
all of its services. As a part of this evaluation, we ask the agency representatives who have requested
National Center 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. This estimate includes time for reviewing the instructions and completing the questionnaire. Send
comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the National Center. Please note your responses to this
questionnaire are confidential. The identity of individual respondents is not recorded.

1. What prompted the request for consultation and upfront assessment services from the
National Center?
________________________________________________________________
_________________________________________________________________

2. Briefly describe the services the National Center provided?
_________________________________________________________________
_________________________________________________________________

3.
0

Rating Scale
1

Do not agree
at all

2

3

4

5

Moderately
agree

6

7

8

9

10

Completely
agree

4. Using the scale above, please rate the extent to which you agree with the following
statement:
Rating
____

The National Center’s services (including the contractor services, if applicable)
helped us determine how best to proceed to solve this problem/resolve this conflict.

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5. Using the scale from the previous page, please rate the extent to which you agree with
the following statements about the consultation and assessment services provided by
the National Center (including the work conducted by the contracted practitioner).
Rating
____

Key issues were explored.

____

Key issues were considered in the recommendations on how to proceed.

____

Input was sought from key parties to the situation/controversy.

____

I would use a situation/conflict assessment again for similar situations.

6. Please indicate your overall level of satisfaction with the National Center’s services:
Totally
Dissatisfied

Mostly
Dissatisfied

Somewhat
Dissatisfied

Neither
Satisfied nor
Dissatisfied

Somewhat
Satisfied

Mostly
Satisfied

Totally
Satisfied















Please elaborate:
_________________________________________________________________
_________________________________________________________________

7. What are the anticipated benefits/impacts of the National Center’s services?
__________________________________________________________________
_________________________________________________________________

8. If your work with the National Center were starting over again, what changes would
you like to see happen?

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_________________________________________________________________
_________________________________________________________________

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS QUESTIONNAIRE.

PERSONS WITH DISABILITIES WHO REQUIRE ALTERNATIVE MEANS FOR
COMMUNICATION OF PROGRAM EVALUATION INFORMATION SHOULD CONTACT
THE NATIONAL CENTER AT (520) 901-8544.

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