Form 0970-0303 Appendix E_Publication Survey

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Public reporting burden for this collection of information is estimated to be 3 minutes per response to complete this questionnaire. 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. The control number for this project is 0970-0303. The control number expires on XX/XX/XXXX.

ublication Survey

Product/Publication Title:______________________________________________________________

Please rate your agreement with the following statements using this scale:

SD – Strongly disagree

D – Disagree

N – Neither agree nor disagree

A – Agree

SA – Strongly agree

NA – Not applicable

I am satisfied with the content of <insert name of product/publication>.	SD	D	N	A	SA	NA
<insert name of product/publication>.is easy to read and understand.	SD	D	N	A	SA	NA
<insert name of product/publication>.is useful.	SD	D	N	A	SA	NA
I would recommend <insert name of product/publication> to others.	SD	D	N	A	SA	NA

1. How are you using or do you intend to use the information in <insert name of product/publication>? (Check one)

• Provide information for families

• Research

• Service delivery

• Professional development

• Program improvement

• Fundraising/grant writing

• Policy development

• Public awareness

• Other: __________________________________

• Personal use (personal situation, school report)

2. Do you plan to use this information to train others:

• Yes

• No

2. What would have made <insert name of product/publication> more helpful to you?

2. How did you learn about <insert name of product/publication>?

• Child Welfare Information Gateway E-lert! (email/listserv notification)

• Child Welfare Information Gateway website

• Conference

• Facebook

• Other organization’s website or publication

• Referred by a colleague/friend

• Other: ___________________________________

2. Which of the following best describes your professional background or role in the child welfare field? (Check one)

• CPS/Child welfare/Foster care professional

• Child abuse prevention/Family support professional

• Adoption professional

• Educator/Faculty

• Other professional:___________________

• Student (e.g., K-12 or University)

• None of the above – I contacted Information Gateway for personal and NOT professional reasons.

2. In which state/territory is your work geographically located? (drop down list)_____________

2. Do you work in a State, county, or community based agency/organization? Yes No (drop down)

2. Do you work with American Indian/Alaska Native/Native Hawaiian populations? Yes No (drop down)

2. Do you have any suggestions or recommendations to make future products/publications more useful (e.g., different format, more interactive, specific topics)?

Thank you very much for your participation. Your time and input are greatly appreciated.