CSP Feedback Questionnaire Screen Shot

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Comprehensive Suicide Prevention (CSP) Evaluation
Learning Network Questionnaire

Thank you for participating in today's event! To help us meet your training and technical assistance (TTA) needs,
support your work, and strengthen connections with CDC and other funded recipients, please take a few minutes to
complete this brief feedback questionnaire. Your participation is voluntary and your responses will be kept
anonymous. Question 1 is required; the following questions are optional. You may choose to skip questions that you
do not wish to answer or discontinue the questionnaire at any point. 

OMB No: 0920-1050
Exp. Date: xx-xx-xxxx
The public reporting burden of this collection of information is estimated to average 10 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
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 H-21, Atlanta, Georgia 30333; ATTN: PRA (0920-1050). 
1. Overall, how satisfied are you with this event?
Very dissatisfied
Somewhat dissatisfied
Somewhat satisfied
Very satisfied
Prefer not to answer

Learning Objectives

2. Please rate your level of understanding/agreement with the following statements about
what you learned in this event. 
Strongly
Disagree

Disagree

Agree

Strongly Agree

As a result of this event, I better
understand   Topic/Learning
Objective 1.
As a result of this event, I better
understand  Topic/Learning
Objective 2.

The topic(s) aligned with my
organization's needs and
priorities.
I gained new knowledge or skills
that are relevant to my
professional work.

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I am confident in my ability to
implement what I learned from
this event.

3. Have you experienced any challenges in putting information you've learned today or from past events into
practice?
Yes
No
If yes, what were they and what support could be provided to mitigate these challenges in the future?

Quality of Event

4. Please rate your level of agreement with the following statements about the quality of this
event.
Strongly
Disagree

Disagree

Agree

Strongly Agree

The format/delivery of
information was effective.
The format/delivery of
information was engaging.
The presenter(s) was
knowledgeable about the topic.
I feel more connected to other
recipients as a result of this
event.
The event balanced time for the
presentation(s) with
opportunities for participant
interaction.
I had opportunities to share my
own experiences and collaborate
and learn from others in this
event.
This event created a welcoming
and engaging environment for
learning.
I found this event a good use of
my time.

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Connections and Future Participation
5. What evaluation topics or themes would you like to see covered in future events?

6. Would you like more opportunities to connect with others outside the CSP Evaluation Learning Network?
Yes
No
Not sure
If yes, how would you like CDC to facilitate this?

If no, why not?

If not sure, please elaborate. Are there any barriers to connecting with others?

7. Would you be interested and willing to share about your work at a future event?
Yes
No
If yes, please indicate if there is a specific topic or project you would like to share.
If you would like to share a topic or project, please share your recipient information at the end of the survey and/or
reach out to [insert contact information here].

8. What would you do to improve this event? (Select all that apply.)
Offer the event at a more convenient time
Provide more/better information before the event
Decrease the length of the event
Increase the length of the event
Increase the amount of content covered
Reduce the amount of content covered
Include or increase small group/interactive portions
Remove or reduce small group/interactive portions
Other
No improvement or recommendations necessary at this time
If other, please elaborate:

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9. We value your insights! Please share your feedback about CSP Evaluation Learning Network
events as a whole using the following prompts.
What could CDC start doing to improve the CSP Evaluation Learning Network?

What practices are not working in the CSP Evaluation Learning Network?

What is CDC doing well that should continue in the CSP Evaluation Learning Network?

10. What is your primary role in supporting CSP?
Communications
Epidemiologist
Evaluator
Financial Staff
Program Lead/ Project Manager
Program Staff
Other
If other, please specify:
__________________________________

Thank you for your participating in this questionnaire!
The following question is optional.
This is an anonymous questionnaire, but if you would like to share your recipient information,
please choose from the dropdown below. 

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Recipient
Arkansas
Bexar County, Texas
California
Colorado
Connecticut
Florida
Georgia
Illinois
Louisiana
Maine
Massachusetts
Michigan
New York
North Carolina
NYS OMH - SPCNY
Ohio
Oregon
Puerto Rico
Rhode Island
Tennessee
University of Nebraska
University of North Dakota
University of Pittsburgh
Vermont
Wisconsin
Would you like someone on the CDC CSP team to follow-up with you about your responses to this survey?
Yes
No
For any technical assistance needs or to discuss sharing your work at upcoming events or trainings feel free to reach
out to us at [insert contact information].

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