Evaluation of U.S. Army Coaching for Resilience and Trauma-Informed Leadership Training Pilot (TILT)

Appendix B. Coaching for Resilience Feedback Form

Timeframe: During session 4 closeout

Text in blue is language that we will clarify with Ft. Leonard Wood and CSF2 once the coaching implementation staff have finalized language to be used on site.

Welcome to the Soldier Feedback Form for the Coaching for Resilience Program

Thank you for providing brief, anonymous feedback about your experience with the Coaching for Resilience program. Your feedback is voluntary and should take less than 5 minutes to complete. When you complete the form, you will receive a $5 e-gift card as a thank you for your time. The Department of Defense has contracted with NORC at the University of Chicago, an objective, nonpartisan research organization, to evaluate the Coaching for Resilience program. Your honest input will help inform improvements to this training for early career Soldiers.

If you have any questions about this survey or the evaluation being conducted by NORC, please contact the NORC Project Team by email: ArmyResilience@norc.org.

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.

Privacy Advisory: Personal contact information is being collected and used by the NORC at the University of Chicago (NORC) for the purpose of distributing gift cards in thanks for your participation. Your information will be securely stored by NORC, will not be delivered to DoD for any non-stated purpose, and will be destroyed no later than September 28, 2027, at the conclusion of NORC’s contract. Providing your information is voluntary, however, choosing not to provide your personal contact information will result in NORC’s inability to offer the $5 gift card as a thank you for your participation today.

By clicking ‘Next’ you indicate your agreement to provide anonymous feedback.

1. Did you set “SMART goals” with your coach?

   • No – not that I know of

   • Yes – but I do not remember them

   • Yes – I remember them

Please rate the degree to which you agree with the following statements:

2. I felt comfortable working with my coach.

• Strongly Agree

• Agree

• Disagree

• Strongly Disagree

3. I felt comfortable discussing my personal development progress with my coach.

   • Strongly Agree

   • Agree

   • Disagree

   • Strongly Disagree

4. I learned at least one specific technique from my coach to achieve my goals.

• Strongly Agree

• Agree

• Disagree

• Strongly Disagree

5. If you learned at least one technique, please specify here: ____________________

6. I would recommend these coaching sessions to other incoming soldiers.

   1. Strongly Agree

   2. Agree

   3. Disagree

   4. Strongly Disagree

7. I expect that the coaching sessions are going to help me meet the demands of the Army.

   1. Strongly Agree

   2. Agree

   3. Disagree

   4. Strongly Disagree

8. Do you have any additional thoughts you’d like to share about the coaching program? As a reminder, please do not share any details that could be used to identify yourself or anyone else.

[open ended]________________________________________________

Thank you for completing this feedback form. Email ArmyResilience@norc.org if you have any questions.

PLEASE CLICK ‘SUBMIT’ BELOW TO SUBMIT YOUR ANONYMOUS FEEDBACK.

Thank you for completing this survey. Your responses have been successfully submitted!

We appreciate your responses. If you have questions about this evaluation, please contact NORC by sending an email to ArmyResilience@norc.org.

Coaching for Resilience Program Evaluation—Gift Card Information

Thank you for your time and responses today.

We would like to confirm your contact information to send you details regarding your $5 digital gift card. Your contact information will not be linked with any of your anonymous feedback provided today, or used for any non-stated purpose. Your contact information will not be shared with anyone in your Army unit or chain of command or in the DoD

If you do not wish to provide your information to receive the e-gift card, you may close this window now.

Note that once you close this window, you will not be able to provide your information to receive your e-gift card in the future.

Enter your last name. ____________

Enter your personal email address. ______________

Is the below information correct?

Name: [LNAME]

Personal Email: [EMAIL]

Please make your selection and click NEXT:

1 Yes, the above is correct. → CONTINUE TO CLOSE

2 No, I need to make a correction. → GO TO PUPDATE SCREEN

UPDATE

Please edit your responses below to update the information, then hit “Next.”

LNAME_UP

Last name: __[LNAME] __________

EMAIL_UP

Email: __[EMAIL] __________

Click ‘Submit’ below to provide your name and email (not any of your survey responses!) for your e-gift card.

Thank you. We will send your follow-up survey in about three months, so please watch for our email address!

If you have any additional questions about the CFR evaluation, please contact ArmyResilience@norc.org.

Please close this tab to end your session.

Resources Screen

National Resources for Soldiers

Suicide or Self-Harm

Suicide Prevention Lifeline
TOLL-FREE: 988
This crisis lifeline provides 24/7 confidential support (via text, call, or chat) and help if you are feeling mental health struggles, emotional distress, depression, substance abuse concerns, and/or thoughts about suicide. Judgement-free counselors are available to provide immediate support.

Domestic Violence

National Domestic Violence Hotline
TOLL-FREE: 1-800-799-7233 or TTY
This hotline provides 24/7 support (via text, call, or chat) to talk confidentially if you are experiencing domestic violence, seeking resources or information, or questioning unhealthy aspects of your relationship.

National Network to End Domestic Violence (NNEDV)-Safety Net Project
techsafety.org
This website provides resources and information on the use of technology for agencies and survivors of domestic violence, sexual assault, stalking, and trafficking. These include survivor, agency, app safety center, confidentiality, and legal systems toolkits.

National Network to End Domestic Violence (NNEDV)
womenslaw.org or womenslaw.org/es (Español), Email Hotline: hotline.womenslaw.org/public

This website provides information relevant to anyone with questions about domestic violence, sexual violence, and other relevant topics. The email hotline site will provide legal information to anyone, not just women, who reaches out with legal questions or concerns regarding these topics.

Love is Respect, National Dating Abuse Helpline
TOLL-FREE: 1-866-331-9474

TEXT: ‘LOVEIS’ to 22522
This support line provides 24/7 assistance and help if you or someone you know is in an unhealthy or unsafe dating relationship, no matter how casual, or if you want to know more about personal safety and healthy relationships. Call center support is offered via text, call, or chat.

Sexual Assault

National Sexual Assault Hotline
TOLL-FREE: 1-800-656-HOPE (4673)
hotline.rainn.org/online
(Español) hotline.rainn.org/es

• This hotline connects you to a trained staff member from a sexual assault service provider in your area. The staff member can provide confidential support (via online chat or call) in finding local resources, such as referrals for long-term support and information about the laws in your community. You can also access 24/7 help online by visiting https://hotline.rainn.org/online.

• The Rape, Abuse, Incest National Network (RAINN) is a partnership of more than 1,100 local rape treatment hotlines that maintains an online referral resource directing you to local rape crisis centers nationwide.

Mental Health Services

SAMHSA’s National Helpline
(Substance Abuse and Mental Health Services Administration)
TOLL-FREE 1-800-662-HELP (4357)
SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

NAMI (National Alliance on Mental Illness)
HelpLine 1-800-950-NAMI (6264)
The NAMI HelpLine is a free, nationwide peer-support service providing information, resource referrals, and support to people living with a mental health condition, their family members and caregivers, mental health providers, and the public. HelpLine staff and volunteers are experienced, well-trained, and able to provide guidance. To contact the NAMI HelpLine, call 800-950-NAMI (6264), Monday through Friday, 10 AM –8 PM ET, or email info@nami.org.

Victim Services

National Center for Victims of Crime
TOLL-FREE: 1-855-4-VICTIM (1-855-484-2846)
victimconnect.org

• This website has information to help victims of crimes learn about their rights and options confidentially. It provides a phone-based helpline, an online chat tool, and web-based information and service referrals.

• This hotline provides support and directs you to a state referral service for legal assistance or mental health care providers. They can also refer you to a local service provider who can provide more specific referrals. This number can be reached Monday-Friday from 12 PM-5 PM ET.

Stalking Prevention and Awareness Resource Center (SPARC)
stalkingawareness.org
SPARC provides nationwide training, technical assistance, and resources to allied professionals, including victim service providers, law enforcement, prosecutors, court personnel, judges, corrections, treatment providers, mental health professionals, campus student conduct offices, campus police/security, Title IX offices, and others.

National Human Trafficking Hotline
TOLL-FREE: 1-888-373-7888
Text “BeFree” (233733)
polarisproject.org
This national hotline provides 24/7 support to answer calls, texts, and live chats from anywhere in the United States in more than 200 languages. The National Hotline’s mission is to connect human trafficking victims and survivors to critical support and services to get help and stay safe and to equip the anti-trafficking community with the tools to combat all forms of human trafficking effectively.

Digital or Media Victims Services

Nonconsensual Pornography Hotline
TOLL-FREE: 1-844-878-CCRI (2274) Cyber Civil Rights Initiative Helpline
This hotline provides 24/7 support to victims of nonconsensual pornography (“NCP”, also known as “revenge porn”), recorded sexual assault (RSA), or sextortion. They can provide information, support, referrals, and non-legal advice.

FAQ Screen

Who is NORC at the University of Chicago?

NORC is a not-for-profit survey and research organization that is working with the U.S. Army and the Sexual Assault Prevention and Response Office (SAPRO) to evaluate the Coaching for Resilience (CFR) program currently being piloted at Ft. Leonard Wood. For more information about NORC, visit www.norc.org.

How do I know this form is anonymous?

All survey responses will be stored separately from your PII – your name and email. You will not be asked to enter any PII to complete the feedback form. If you would like to receive the $5 e-gift card, NORC will redirect you to a separate survey to collect your contact information. This information will not be linked to your responses. NORC will use your contact information to deliver incentives and other survey-related communication.

How long will this form take to complete?

The form will take about 5 minutes to complete.

Why should I participate?

The benefits to your participation may include better prevention programming and a more supportive environment for soldiers on base. The feedback provided in this form will be used to better understand the experiences soldiers are having in coaching sessions and will aid NORC’s evaluation of the CFR program.

Any immediate benefit to me?

You will receive a $5 e-gift card for completing this feedback form today.

Do I have to fill out this form?

No, you do not have to fill out the feedback form. It is voluntary, but in order to receive a $5 e-gift card, you must provide your information after completing the feedback form.

What is this form about?

This feedback form is part of an evaluation of the CFR program. The goal of collecting this feedback is to better understand the experiences soldiers are having with CFR at Ft. Leonard Wood.

Technical Assistance Screen

This feedback form is best viewed on a laptop, desktop, or large tablet running the current Firefox, Chrome, Safari, or Edge versions.

You can go forward or backward in the form by clicking the Next or Back buttons. (DO NOT use your browser’s Back or Forward buttons).

If you leave the feedback form idle for more than 10 minutes, it will time out to keep your responses confidential. All the responses you provided up until the feedback form timed out are saved.

For other technical support questions, or if you encounter any problems as you complete the survey, please contact NORC at ArmyResilience@norc.org. for assistance.