Form 1 Adaptive Leadership Academy Completion Survey

OMB No: 0906-0084

Expiration date: 02/28/2027

Adaptive Leadership Academy (Completion) Survey

Public Burden Statement: The purpose of this information collection request is to assess participant satisfaction with various training and TA activities offered through a contracted TA provider, the Education Development Center. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0906-0084 and is valid until 02/28/2027. This information collection is voluntary. All responses will be aggregated and respondents will remain confidential. Public reporting burden for this collection of information is estimated to average .12 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Information Collection Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857 or paperwork@hrsa.gov.

1. Overall, how satisfied were you with the Adaptive Leadership Academy?

   1. Extremely satisfied

   2. Satisfied

   3. Dissatisfied

   4. Extremely dissatisfied

2. [If chosen “Dissatisfied” or “Extremely dissatisfied”] Please explain why you were dissatisfied with the Adaptive Leadership Academy: [Open text]

3. What was the MOST helpful feature(s) of the Adaptive Leadership Academy? Please select all that apply.

   1. Virtual sessions

   2. In-person session

   3. Pre-work

   4. Change challenge project

   5. Small group discussions

   6. Coaching

   7. Other, please explain:

4. What was the LEAST helpful feature(s) of the Adaptive Leadership Academy? Please select all that apply.

   1. Virtual sessions

   2. In-person session

   3. Pre-work

   4. Change challenge project

   5. Small group discussions

   6. Coaching

   7. Other, please explain:

5. Have you taken any action steps as a result of your participation in the Adaptive Leadership Academy?

   1. Yes

   2. No

6. [If yes] Please describe 1-2 action steps you have taken as a result of your participation in the Adaptive Leadership Academy: [Open text]

7. [If no] Please describe how the Adaptive Leadership Academy could have better supported you in taking action: [Open text]

8. Did you experience any barriers to participating in the Adaptive Leadership Academies, including participating in the coaching calls, virtual sessions, or on the MALL?

   1. Yes, I’ve experienced barriers

   2. No, I’ve not experienced any barriers

9. [If yes] Please describe the barriers you experienced that kept you from participating fully in the Adaptive Leadership Academies: [Open text]

10. Please describe how can we improve future Adaptive Leadership Academies? [Open text]

11. Please rate your agreement with the following statement: The Adaptive Leadership Academy integrated diversity, equity, and inclusion into the content it provided.

    1. Strongly agree

    2. Agree

    3. Disagree

    4. Strongly disagree

12. To what extent did you see diversity, equity, and inclusion show up in the approach of the technical assistance provided?

    1. To a great extent

    2. Somewhat

    3. Very little

    4. Not at all

13. Please comment with any suggestions for how we can improve our technical assistance to more intentionally integrate diversity, equity, and inclusion.

14. As we work to improve the TARC’s Adaptive Leadership Academy, would you be willing to connect with us if we wanted to follow up on some of the feedback you provided (we would contact you via email)?

    1. Yes, I would be willing to speak with you.

    2. No, I would prefer not to.

15. [If yes] Please provide your email [Open text]