Form SV-2010-0022 Iraqi Young Leaders Exchange Program (IYLEP) Post-Progra

Iraqi Young Leaders Exchange Program
[Insert Year] Post-Program Survey

	Congratulation on finishing your Iraqi Young Leaders Exchange Program! Before you leave we would like to ask you a few questions about your program, plans, and opinions. Please know that your answers will be strictly confidential! We will use the data for analytical and evaluative purposes only. Please feel free to give us your honest opinions. This survey is not a test, and there are no right or wrong answers. Thank you for your participation in this survey.

	Privacy Act and Paperwork Reduction Act Statements: The information solicited on this survey is requested pursuant to the Government Performance and Results Act of 1993 (P.L. 103-62) and the Mutual Educational and Cultural Exchange Act of 1961, as amended, also known as the Fulbright-Hays Act (22 U.S.C. 2451, et seq.). In order to ensure that the U.S. Department of State’s international exchange programs meet statutory program requirements (22 U.S.C. 2460(c)), the Department’s Bureau of Educational and Cultural Affairs (ECA) regularly monitors the programs, gathers data about program accomplishments, and evaluates selected ones. ECA uses the information collected to inform program design, management, and funding. All personal information that is collected through surveys is considered confidential. All responses are coded to ensure the confidentiality of individual responses. Data collected under this study will not be shared, sold, or used for fundraising purposes. Survey data and findings will be used only in an aggregate form for the express purposes of fulfilling the data needs of the outcome assessment. Responses to this survey are voluntary. Public reporting burden for this collection of information is estimated to average thirty (30) minutes to respond to this survey, including 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 respondents are not required to respond to, a collection of information unless it displays a valid OMB control number. Please send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to: A/ISS/DIR, U.S. Department of State, Washington, D.C. 20520.

1. Please identify your exchange group:

[Insert Group 1]
[Insert Group 2], etc.

2. Exchange programs provide participants with many important opportunities for learning and engaging people from other countries. In the table below, please identify the three most important accomplishments of your Iraqi Young Leaders Program.

Gained experience and knowledge about leadership
Learned about community development (how to improve my neighborhood and community)
Increased my understanding of the United States, American society, people, and culture
Learned about government in the United States
Made friends with American students and their families
Made friends with other Iraqi participants in the program
Shared my culture with others
Represented my country abroad
Other (Please write in): _________________________________________

	3. What did you teach Americans or other Iraqi participants who interacted with you while on the program? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

4. To what extent did you have opportunities to share information about your home country or region with people you met while in the United States? Please check one box in each row.

	Not At All	To A Small Extent	To A Good Extent	To A Great Extent
Culture, society and values of Iraq
Foreign policy of Iraq
General information about Iraq
United States relations with Iraq
View of global issues

5. Please rate your satisfaction with the following program components. Please check one box in each row.

	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Administration
Content
Variety of Experiences
Relevance of program to professional or educational development

6. Please rate your satisfaction with the specific program components of the Iraqi Young Leaders Program listed below. Please check one box in each row.

	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied	Not Applicable
Information received about the program prior to departure
Pre-departure orientation
Administration/organization (for example: whether program events were well-planned and run efficiently, whether scheduling and itinerary was well-organized)
Program staff
Special program classes (about democracy, government)
Leadership training activities
Community service activities
Site visits, trips, and meetings
Home stay with family
Camp activities
Amount of interaction with American teenagers
Sensitivity of program to your cultural or religious needs
Cultural/entertainment activities

7. Please rate yourself on the following abilities. Please check one box in each row.

	Poor	Fair	Good	Excellent
Being self-reliant, being independent, relying on yourself
Speaking in public
Listening to other people's suggestions or concerns
Expressing ideas and feelings
Being tolerant (respectful) of others different than you
Leading a team and motivating others
Being flexible
Solving problems
Planning for the future
Managing your time
Managing money
Discussing your beliefs/values
Willing to make changes in your community

8. How much do you agree/disagree with the following statements about you as an individual? Please check one box in each row.

	Strongly Disagree	Somewhat Disagree	Neither Agree Nor Disagree	Somewhat Agree	Strongly Agree
I feel I have many choices in my life
I feel I can make a difference in my family
I feel I can make a difference in my community
I feel I can influence people around me

	9. What does community service mean to you? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

10. Please rate your current knowledge and understanding of the topics listed below. Please check one box in each row.

	No Knowledge	Less Than Basic	Basic Knowledge	Beyond Basic	Advanced Knowledge
Leadership
Community service (for example: people helping others in their neighborhood, community, or local organization)
Community development (for example: people working together to improve their neighborhood and community)
Local government (for example: government in individual provinces, districts, towns or villages)

11. While you were in the United States, how much did you improve your knowledge and understanding of the following topics and themes? Please check one box in each row.

	Not At All	Somewhat	A Good Deal	A Great Deal	Unsure
Leadership
Community service (for example: people helping others in their neighborhood, community, or local organization)
Community development (for example: people working together to improve their neighborhood and community)
Local government (for example: government in individual provinces, districts, towns or villages)

	12. What did you accomplish or learn during this visit to the United States that you could not accomplish or learn at home? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

13. As a direct result of your participation in the exchange program, do you think you will do or receive any of the following at school/university? Please check one box in each row.

	Yes	No
Higher level of responsibilities or leadership at school/university
Organize or initiate new activities or projects at school/university
Established a new organization at school/university

14. As a direct result of your participation in the exchange program, do you think you will do or receive any of the following in your community? Please check one box in each row.

	Yes	No
Assume a leadership role or position in your community
Organize or initiate new activities or projects in your community
Establish a new organization in your community

15. Do you think you will share your program experience or the knowledge you gained during your exchange in any of the following ways? Please check one box in each row.

	Yes	No
Participate in media interviews (newspaper, television, radio, Internet)
Give presentations to community, neighborhood, school or university groups
Write newspaper articles, including editorials and opinion pieces
Create a website
Post on a Blog or other Internet networking space (for example: MySpace, Facebook, Linked-in)
Other (Please write in): _________________________________________

16. Please rate your knowledge or understanding of the following topics. Please check one box in each row.

	No Knowledge	Less Than Basic	Basic Knowledge	Beyond Basic	Advanced Knowledge
United States democracy
United States economy
United States values and culture
Religious and ethnic diversity in the United States
Freedom of speech and press in the United States
Voluntary community service in the United States
Daily life in the United States

17. How much did participation in the program change your understanding or knowledge of the following topics? Please check one box in each row.

	No Change	Minimal Change	Moderate Change	Substantial Change
United States democracy
United States economy
United States values and culture
Religious and ethnic diversity in the United States
Freedom of speech and the press in the United States
Voluntary community service in the United States
Daily life in the United States

	18. What did you learn about the United States that surprised you or that you did not expect? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

19. How do you view the United States government and the American people? Please check one box in each row.

	Strongly Unfavorable	Generally Unfavorable	Neither Favorable Nor Unfavorable	Generally Favorable	Strongly Favorable
United States Government
American people

20. How did your views of the United States Government and the American people change as a result of your program participation? Please check one box in each row.

	Much Less Favorable	Less Favorable	No Change	More Favorable	Much More Favorable
United States Government
American people

21. How do you view the United States government and its relationship with your home country?

	Strongly Disagree	Disagree	Neither Agree Nor Disagree	Agree	Strongly Agree
The United States Government is a trustworthy partner for my country

	22. What did you like best about this program? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

	23. What did you like least about this program? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

24. Do you think you will remain in contact with people you met during your exchange program?

Yes
No

25. Which best describes the geographic location where you live. Please check one box.

My country's capital city
Another major city in my country other than the capital
A small city, town, or rural location in my country

26. Age: [Drop-down list]

27. Gender:

Female
Male

28. Do you know about the State Department Alumni website, https://alumni.state.gov? Please check one box.

Yes
No

29. Have you registered for the State Department Alumni website, https://alumni.state.gov? Please check one box.

I have registered
I have not yet registered
I do not plan to register

	30. Thank you for completing this survey! If you have additional comments you would like to make, about any of the things above, about your participation so far, about what you have been proud to share, or something we have not touched upon, please do so here. We value your thoughts very much. ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

	31. How long did it take you to complete this survey?  ________ Minutes

1 SV-2010-0022

OMB No.: 1405-0158

Expiration Date: 04/30/2011

Estimated Burden Time: 30 minutes