Orientation Assessment Instrument

Form Approved

OMB No. 0920-1050

Exp. Date 06/30/2025

CDC estimates the average public reporting burden for this collection of information as 3 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1050).

Orientation Assessment Instrument

Thank you for joining the orientation session for the program. We appreciate your time, effort, and candor in responding to our questions.

The purpose of this assessment is to gather your immediate impression of today’s meeting to inform future convenings. Please remember that any information you share with us are done in a secure manner (i.e., your name will not be associated in any way with your responses).

Please feel free to reach out to the NNPHI evaluation team directly (Emily Costello, ecostello@nnphi.org) if you have additional thoughts that you would like to share, or feedback that you would like us to provide to the team.

1. The length of the orientation was… The Single Choice

• Too short

• About right

• Too long

2. How clear is your understanding about the following after attending the program orientation? Likert scale

• The purpose of the program

• Components of the program

• Support available to participants, including point(s) of contact

• Program logistics, dates, and expectations

• Program Timeline

• Evaluation approach

Very unclear = 1; Slightly unclear = 2; Unsure= 3; Slightly clear = 4; Very clear =5

3. What additional information would be helpful? Open ended response

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4. To what extent do you agree with the following statements about the orientation? Likert scale

• I was able to clearly understand and follow the presentations.

• The content of the orientation session met my expectations.

• I was given adequate opportunity to get answers to my questions

• My questions were answered.

Strongly Disagree= 1; Disagree = 2; Unsure = 3; Agree= 4; Strongly Agree= 5

5. After attending the orientation, do you have any remaining questions about the program? Single Choice

• No

• Yes

If yes, please explain: Open text box

6. Is there any other feedback you would like to share with us about the program? Open ended

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