Evaluation of the U.S Marine Corps' Prime for Life 4.5 Program

OMB Control Number 0704-0644

OMB Expiration: 1/31/2026

PFL 4.5 Instructor Fidelity Worksheet

[GENERAL SURVEY INSTRUCTIONS, ITEM LABELS, AND PROGRAMMING NOTES INDICATED IN BLUE. TEXT WILL NOT APPEAR IN SURVEY.]

If a respondent is presented with an item and no response is given, then fill the input variable with a value of 98. Every item should include the 98 code.

[RESPONSES REFLECTING FIDELITY ARE NOTED IN GREEN.]

Thank you for providing feedback regarding the Prime for Life 4.5 session you conducted today. Completing this form is voluntary. Your data will be held securely and only used for program evaluation purposes (not instructor evaluation purposes). Your responses will be combined with others to help DoD and USMC leadership improve the Prime for Life 4.5 course.

OMB CONTROL NUMBER:  0704-0644

OMB EXPIRATION DATE: 01/31/2026

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information, 0704-0644, is estimated to average 6 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. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

1. [INITIALS] Enter your initials: ____________________ [OPEN END]
   
   
   

2. [SESSION_DATE] Date of today’s Prime for Life 4.5 session: ______________ [ENTER DATE MM/DD/YYYY]
   
   
   

3. [SESSION_TIME] Start time of today’s Prime for Life 4.5 session: ______________ [ENTER TIME]
   
   
   

4. [SESSION_PARTIC] How many participants attended the session? _____ [ENTER NUMBER]
   
   
   

5. [RATE] How well did today’s session go?

Very Poorly Average Well Very

Poorly Well

1 2 3 4 5

6. [USESLIDES] Did you use the slides to present Prime for Life 4.5 today?

• Yes, I used the slides to present the entire Prime for Life session today. (1)

• Yes, I used the slides to present most of the Prime for Life session today. (2)

• Yes, I used the slides to present some of the Prime for Life session today. (3)

• No, I did not use the slides to present Prime for Life today. (4)
  
  
  

7. [DISPLAY ON SAME SCREEN IF USESLIDES=“No”] [USESLIDES_OE] Please describe why you did not use the slides to present Prime for Life 4.5 today: _____________________ [OPEN ENDED RESPONSE]
   
   
   

8. [ANYCHANGES] Did you make any changes to how the content for today’s Prime for Life 4.5 session was delivered?

(Select “Yes” if you presented the information in some way other than laid out in the e-manual, made changes to the presentation slides, or reorganized any part of the lesson or material. Do not include changes to examples.)

• No, I did not make any changes. [Display hover definition: The content was delivered as it was designed]. (1)

• Yes, I made minor changes. [Display hover definition: The content was largely delivered as it was designed, but I made a few cosmetic changes, such using as a different example than what is in the instructor guide]. (2)

• Yes, I made moderate changes. [Display hover definition: The content was usually delivered as it was designed, but I made a few more major changes, such as rushing through a section or including a new activity]. (3)

• Yes, I made major changes. [Display hover definition: The content was not delivered as it was designed, and I changed major parts of the course, such as skipping a whole unit]. (4)

9. [DISPLAY ON SAME SCREEN IF ANYCHANGES=2, 3, or 4] [ANYCHANGES_OE] Please describe the change(s) you made. ________________________________________ [OPEN ENDED RESPONSE]

10. [DISPLAY ON SAME SCREEN IF ANYCHANGES=2, 3, or 4] Please select the reason(s) for the changes to today’s session. Select all that apply

• [CHANGES1] Not enough time (1)

• [CHANGES2] Technical difficulties (2)

• [CHANGES3] Participants did not understand the material (3)

• [CHANGES4] I was uncomfortable discussing some of the topics (4)

• [CHANGES5] Participants seemed uncomfortable discussing some of the topics (5)

• [CHANGES6] Participants engaged in conversation for longer than anticipated (6)

• [CHANGES7] I thought of a new activity that would be relevant to my group (7)

• [CHANGES8] I included a new example that would be relevant to my group (8)

• [CHANGES9] Participants wanted to learn more about an appropriate, related topic (9)

• [CHANGES10; CHANGES10_OE] Other (please explain): _______________________ (10; OPEN ENDED RESPONSE)
  
  
  

10. [USEMANUAL] In this session, how closely did you rely on the Prime for Life 4.5 e-manual to get through the lectures and exercises?

• I had the e-manual open and read to the class from it to make sure I got the concepts correct (1)

• I had the e-manual open and checked it on many or most slides to ensure I had covered all the relevant points (2)

• I had the e-manual open, but rarely checked it (e.g., once every 20 slides) (3)

• I kept the e-manual closed, and just used the slides and my notes to teach (4)

10. [NOTINMANUAL] In this session, how much material was discussed that is not included in the manual?

• A lot of material was discussed that is not included in the manual (1)

• Some material was discussed that is not included in the manual (2)

• A little bit of material was discussed that is not included in the manual (3)

• Only material that is included in the manual was discussed (4)

10. In this session, how often did you encounter the following situations?

	Not at all	Once or twice	Frequently
[PARTIC_ISSUES1] Participants who seemed unengaged or disinterested in the training.	0	1	2
[PARTIC_ISSUES2] Participants who struggled to understand the material.	0	1	2
[PARTIC_ISSUES3] Participants who seemed to resist the material.	0	1	2
[PARTIC_ISSUES4] Participants who were confrontational or argumentative.	0	1	2
[PARTIC_ISSUES5] Participants who were especially engaged or interested in the training.	0	1	2
[PARTIC_ISSUES6] Participants who shared relevant additional experiences for discussion.	0	1	2
[PARTIC_ISSUES7] Participants who wanted additional resources related to the training.	0	1	2

10. [COMMENT_OE] Please provide any additional comments or observations about the most recent Prime for Life 4.5 session. ________________________________________ [OPEN ENDED RESPONSE]
    
    

Thank you for your responses. Click the ‘Submit’ button to submit the form.

Thank you for completing the Prime for Life 4.5 Instructor Fidelity Worksheet. You may close this tab and exit the survey.

[END SURVEY]

4