Form SV-2010-0023 Future Leaders Exchange Program (FLEX) Pre-Program Surve

Future Leaders Exchange Program

Pre-Program Survey [Insert Year]

Dear FLEX Student, Congratulations on being chosen as a FLEX participant! Before you leave for your exciting year as an exchange student in the United States, the FLEX Program would like to ask you a few questions. These questions will only be used to evaluate the FLEX Program and to make it better for you and for future FLEX participants. Please answer all of the questions and respond to them as best you can. This is not a test, and there are no right or wrong answers. Your thoughts and opinions are important to us and will not affect your participation in the program. Once you have completed the survey, the American Councils staff will return them anonymously to the office in Washington, D.C. Thank you for your help, and have a wonderful year.

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 twenty (20) 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. Which organization is your placement organization upon arrival in the United States? Please check one box.

4-H Foundation (World Wise)
AFS-USA, Inc.
AIFS/AYA
American Councils
ASPECT Foundation
ASSE
AYUSA
CCI
CIEE
Nacel Open Door
PAX
PIE
World Link
Do Not Know

2. There are many different reasons for participating in FLEX. In the table below, please identify your three most important reasons for participating.

To increase my understanding of American society, people and culture
To promote mutual understanding between both our countries
To make friends with students from other countries
To make friends with American students
To share my culture with others
To acquire leadership skills
To improve my education
To improve my English
To seek opportunities to continue education in the United States
To gain skills that will help my country when I return home
Other (Please write in): ___________________________________________________

3. How difficult do you think it will be to adapt to life in the United States? Please check one box.

	Very Difficult	Somewhat Difficult	Neither Difficult Nor Easy	Somewhat Easy	Very Easy
Adapting to life in the United States will be...

4. What is the first thing that comes to mind when you think about the United States? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

5. What is the first thing that comes to mind when you think about living with an American host family? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

6. 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 of people different from you
Leading a team and motivating others
Being flexible
Solving problems
Discussing your beliefs/values
Willing to make changes in your community
Critical thinking
Using technology (Internet, computer applications)

7. Have you participated in any activities or projects conducted by FLEX alumni in your home country?

Yes
No

8. In the past year, how often were you involved in the following activities? Please check one box in each row.

	Never	Seldom	Some Of The Time	Most Of The Time
Community service (for example: helping others, environment, health, education)
Civic or political activism (for example: elections, writing articles for a newspaper, magazine, school newsletter, blog)
Cultural activities (for example: visiting museums/historical sites, attending concerts, theater)
Family Activities
Religious activities
School clubs or organizations (for example: musicals, band, debate team)
Sports teams
Other (Please write in): ___________________________

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

10. Please rate your understanding or knowledge 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 the press in the United States
Voluntary community service in the United States
Daily life in the United States

11. 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

12. 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

13. To what extent do you agree or disagree with the statements below? Please check one box in each row.

	Strongly Disagree	Disagree	Neither Agree Nor Disagree	Agree	Strongly Agree
Voting is important because real decisions are made in elections
Free and fair elections are the cornerstone of democracy
An independent media is important to the free flow of information
All citizens in a country should have equal rights and protections under the law
The Rule of Law is fundamental to a functioning democracy
Individuals and organizations have the right to free speech and to voice opposition
Teachers should incorporate democratic principles into their classroom practices

14. Do you agree or disagree with the following statements? Please check one box in each row.

	Strongly Disagree	Somewhat Disagree	Neither Agree Nor Disagree	Somewhat Agree	Strongly Agree
Men and women should have equal opportunities
Men and women should equally share family responsibilities
Ethnic minorities should have equal opportunities
People with disabilities (mentally and/or physically challenged) should have equal opportunities
Religious minorities should have equal opportunities

15. Do you agree or disagree with the following statements? Please check one box in each row. In society, an individual should have the right to:

	Strongly Disagree	Somewhat Disagree	Neither Agree Nor Disagree	Somewhat Agree	Strongly Agree
Travel freely to other countries
Have acceptable housing
Be considered equal under law regardless of age, gender, ethnicity or religion
Practice any religion
Receive an education
Have a job
Have acceptable health care
Have access to information
Have freedom of speech

16. Please indicate how strongly you agree or disagree with the following statements about Americans. Please check one box in each row.

	Strongly Disagree	Somewhat Disagree	Neither Agree Nor Disagree	Somewhat Agree	Strongly Agree
Most Americans are wealthy
Americans are friendly and open
Americans are well-informed about the world
Americans express their personal opinions, even if they contradict those of authorities
Americans are peaceful people

17. Please indicate how strongly you agree or disagree with the following statements about the United States. Please check one box in each row.

	Strongly Disagree	Somewhat Disagree	Neither Agree Nor Disagree	Somewhat Agree	Strongly Agree
The United States is a democracy that works well
The United States has laws and regulations that protect the individual
The United States economy provides a good living for its citizens
The United States foreign policy reflects the interests and attitudes of the American people
The United States imposes its views on other countries
The United States provides equal opportunities for all

18. What year of school have you most recently completed? Please check one box.

8th year
9th year
10th year
11th year
12th year

19. How would you describe your school? Please check one box.

Public/government
Private
Do Not Know

20. Were you selected as a finalist or an alternate for the FLEX program? Please check one box.

Finalist
Alternate
Do Not Know

21. 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

22. Home country: [Drop-down list]

23. Age: [Drop-down list]

24. Gender:

Female
Male

25. Which religion do you most closely identify with? Please check one box.

Baha'ism
Buddhism
Christianity (for example: Orthodox, Catholic, Protestant)
Confucianism
Hinduism
Islam
Jainism
Judaism
Shintoism
Sikhism
Taoism
Zoroastrianism
None
Other (Please write in): ___________________________

26. What areas of the world have you traveled to? Please check all boxes that apply.

Africa
Asia
East Asia/Pacific
Europe
Latin America
Middle East/North Africa
North America
Other
Never traveled outside my home country

27. Thank you for completing this survey! If you have additional comments you would like to make, please do so here. We value your thoughts. ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

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

1 SV 2010-0023

OMB No.: 1405-0158

Expiration Date: 04/30/2011

Estimated Burden Time: 20 minutes