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ECR Support Services Evaluation - Requester Questionnaire
OMB Number: 3320-0009
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: ECR Support Services Evaluation - Requester Questionnaire
1. What prompted your request for services from the U.S. Institute?

Base Survey: ECR Support Services Evaluation - Requester Questionnaire
2. What service(s) did the U.S. Institute provide?

Base Survey: ECR Support Services Evaluation - Requester Questionnaire
3. 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: ECR Support Services Evaluation - Requester Questionnaire
4. What are the anticipated benefits/impacts of the U.S. Institute’s services?

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

Base Survey: ECR Support Services Evaluation - Requester Questionnaire
6. Using the scale below, please rate your agreement with the following statements:

6a. The services provided by the U.S. Institute have helped us or will help us determine how
best to proceed to address the environmental conflict(s)/issue(s) discussed.
0 - Do not agree at all

5 - Moderately agree

10 - Completely agree

6b. Overall, the services provided by the U.S. Institute help us improve the effectiveness of
our environmental conflict resolution and collaborative problem-solving efforts.
0 - Do not agree at all

5 - Moderately agree

10 - Completely agree

Base Survey: ECR Support Services Evaluation - Requester Questionnaire
7. Please use the space below for any additional feedback you would like to provide.

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