Form 0920-1050 Participant Feedback Form for Group Learning Events

Att. 2 Participant Feedback Form for Group Learning Events

OMB Control No. 0920-1050

Exp. Date 06/30/2025

Public reporting burden of this collection of information is estimated to average 10 minutes per respondent. 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).

Thank you for participating in today’s event. To help us meet your training and technical assistance (TTA) needs, please take a few minutes to complete the following brief survey. Your participation is completely anonymous and voluntary. All survey questions are optional. You may choose to skip survey questions that you do not wish to answer or discontinue the survey at any point.

Name of Group Learning Event: ______

1. Please indicate whether you are involved in any of the following CDC-funded programs. (Check all that apply.)

• Rape Prevention and Education (RPE)

• Domestic Violence Prevention Enhancements and Leadership Through Alliances (DELTA) AHEAD

• Essentials for Childhood: Implementation of Strategies and Approaches for Child Abuse and Neglect Prevention

• Preventing Violence Affecting Young Lives (PREVAYL)

• Preventing Adverse Childhood Experiences: Data to Action (PACE:D2A)

• Not sure

• Other: _____________________

2. Please describe your type of organization.

• State health department

• Local health department

• State domestic violence coalition

• Community based organization (sub-recipient)

• Other: ______________________

3. Briefly describe your primary role in your organization. _________________

4. Please rate your level of agreement (strongly disagree, disagree, agree, or strongly agree) with the following statements about what you learned in this event.

   As a result of this group TTA event, I better understand…	Strongly disagree	Disagree	Agree	Strongly agree
   Topic/Learning Objective 1				
   Topic/Learning Objective 2				
   Topic/Learning Objective 3				

5. Please rate your level of agreement (strongly disagree, disagree, agree, or strongly agree) with the following statements about the quality of this event.

   	Strongly disagree	Disagree	Agree	Strongly agree
   I intend to use or apply information gained from this event in my professional work.				
   The teaching methods were effective.				
   The presenter(s) was knowledgeable about the topic.				
   My cultural background, traditions, and identities were respected in this space.				
   The event balanced audiovisual presentation with opportunities for questions and discussion.				
   I would recommend future VPTAC events to others.				
   I was inspired to do or think about something differently.				
   The topic(s) was in line with my organization’s needs and priorities.				
   This event provided opportunities for interactions with other recipients and peers.				

6. What would you do to improve this event? (Check all that apply.)

• Provide more/better information before the event

• Reduce the amount of content covered

• Improve the instructional methods

• Offer the event at a more convenient time

• Include or increase small group/interactive portions

• Remove or reduce small group/interactive portions

• Increase the length of the event

• Decrease the length of the event

• Other:________________________

7. Overall, how satisfied were you with this event?

• Very dissatisfied

• Somewhat dissatisfied

• Somewhat satisfied

• Very satisfied

8. How do you intend to use what you’ve learned during this event? Examples include enhancing your organization’s programming, informing training efforts, and informing policy change.

___________________________________________________________________________

9. Please share any additional questions this group event raised for you (or that you brought with you) that you were not able to ask during the event.

___________________________________________________________________________

10. What other topics for group learning events would you like to see offered, including topics that you heard about today that you want to hear more about?

__________________________________________________________________________