Post-Program 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 4 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).

Post-Program Assessment Instrument

Thank you for participating in the program. Your feedback is very important as we plan for future programs to help strengthen the public health workforce.

1. Based on your experience since completing the program, to what extent do you agree with the following statements about the program?

	Strongly Disagree	Disagree	Unsure	Agree	Strongly Agree
The meeting schedule aligned with my schedule.	❒	❒	❒	❒	❒
The meeting program timing aligned with my schedule	❒	❒	❒	❒	❒
I was able to work on the priority areas of focus of the program.	❒	❒	❒	❒	❒
Participating in the program has helped me improve my skills.	❒	❒	❒	❒	❒
Participating in the program helped me improve my knowledge.	❒	❒	❒	❒	❒
Overall, I am satisfied with what I learned in the program.	❒	❒	❒	❒	❒

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

2. Please rate your level of confidence in the following skills and knowledge before and after the program:

How to T		Not confident	Somewhat confident	Unsure	Fairly confident	Completely confident
	a. Specific program skills or knowledge
Before program		❒	❒	❒	❒	❒
After program		❒	❒	❒	❒	❒
	b. Specific program skills or knowledge
Before program		❒	❒	❒	❒	❒
After program		❒	❒	❒	❒	❒
	c. Program skills or knowledge
Before program		❒	❒	❒	❒	❒
After program		❒	❒	❒	❒	❒
	d. Program skills or knowledge
Before program		❒	❒	❒	❒	❒
After program		❒	❒	❒	❒	❒

Not at all confident = 1; Somewhat confident = 2; Unsure = 3; Fairly confident = 4; Completely confident = 5 

3. In which skill(s) and knowledge do you think you have made the most improvement, and why?

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4. In which skill(s) and knowledge do you think you have made the least improvement, and why? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Were there other skills and knowledge where you needed coaching that were not addressed by your coach? If so, what were they?

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6. Was there any other support that would have improved your experience in the program?

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