3320-0003 (D) ECCR Support Services Questionnaire

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

ECR Support Services 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.

What prompted your request for services from the National Center?
______________________________________________________________
______________________________________________________________

What service(s) did the National Center provide?
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

1

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:
_________________________________________________________________
_________________________________________________________________
What are the anticipated benefits/impacts of the National Center’s services?
______________________________________________________________
___
_________________________________________________________________
_________________________________________________________________
If your work with the National Center were starting over again, what changes
would you like to see happen?
_________________________________________________________________
_________________________________________________________________

2

Rating Scale
0

Not at all

1

2

3

4

5

Moderately

6

7

8

9

Using the scale above, please rate your agreement with the following statements:
Rating
____

____

a. The services provided by the National Center have helped us or will help us

determine how best to proceed to address the environmental conflict(s)/issue(s)
discussed. If not applicable, please write N/A.

b. Overall, the services provided by the National Center help us improve the

effectiveness of our environmental conflict resolution and collaborative problemsolving efforts. If not applicable, please write N/A.

Please use the space below for any additional feedback you would like to provide.
_________________________________________________________________
________________________________________________________________

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.

3

10

Completely