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pdfMSY Teen Leaders Program: Advisor Satisfaction Survey
Thank you for your participation in the MediaSmart Youth Teen Leaders Program. We look forward to receiving your
feedback!
___________________________
OMB Number: 09250643
Expiration Date: 10/31/2017
Public reporting burden for this collection of information is estimated to average 30 minutes, including the time for
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NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 208927974, ATTN: PRA (09250643).
Do not return the completed form to this address.
Site Information
*1. Name of Nonprofit Partner Organization:
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*2. City and State
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*3. How did you support the teen(s)/young adult(s) in conducting the program? (Please
check all that apply.)
c Made them aware of the MediaSmart Youth Teen Leaders Program opportunity
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f
g
c Helped them write the application
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c Helped them develop a budget
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g
c Helped recruit participants
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g
c Helped gather parent permission forms
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c Helped teen leader(s) plan for the lessons
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c Helped purchase/gather supplies
d
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c Supervised participants during the lessons
d
e
f
g
c Helped facilitate lessons
d
e
f
g
c Coordinated field trip(s)
d
e
f
g
c Other (please describe)
d
e
f
g
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Satisfaction with MediaSmart Youth Lessons
*4. Please rate your level of agreement with the following statements about the Media
Smart Youth curriculum.
The lessons helped
Strongly Agree
Agree
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Strongly Disagree
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participants think more
critically about media
messages.
Since being in the
program, the participants
have shown a stronger
interest in making healthy
choices, like eating
nutritious foods or being
physically active.
Overall, the MediaSmart
Youth program was a
valuable experience for the
youth participants.
I would recommend that
other organizations use the
MediaSmart Youth
curriculum.
*5. Did you observe any behavioral changes (e.g., making healthier decisions) in
participants as a result of the MediaSmart Youth program?
c Yes
d
e
f
g
c No
d
e
f
g
If yes, please describe.
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*6. Will your organization implement MediaSmart Youth again in the future, either with
teen or adult leaders?
j Yes
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j No
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n
If yes, please explain why. If no, please explain why not.
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*7. Please rate your level of agreement with the following statements about the Media
Smart Youth Teen Leaders Program.
The program helped the
Strongly Agree
Agree
Disagree
Strongly Disagree
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teen(s)/young adult(s) in my
community enhance their
leadership skills.
Based on my experience
with the program, I believe
that teens can be effective
leaders of the MediaSmart
Youth curriculum.
I would recommend that
other teens consider
becoming MediaSmart
Youth Teen Leaders.
*8. How can the MediaSmart Youth Teen Leaders Program be improved?
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Satisfaction with the Level of Program Support
*9. Please rate your level of agreement with the following statements about the level of
support you received as an advisor for the MediaSmart Youth Teen Leaders Program.
I received the support I
Strongly Agree
Agree
Disagree
Strongly Disagree
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needed from the National
Institutes of Health (NIH)
and its contractor, IQ
Solutions.
The webinar training I
received at the start of the
program was helpful.
I felt well prepared to be an
advisor for the MediaSmart
Youth Teen Leaders
Program.
10. What additional support, if any, would you have liked from the NIH and/or its
contractor, IQ Solutions?
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Satisfaction as a Program Advisor
*11. Please rate your level of agreement with the following statements about your
experience as an advisor with the MediaSmart Youth Teen Leaders Program.
Serving as an advisor was a
Strongly Agree
Agree
Disagree
Strongly Disagree
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positive experience.
Serving as an advisor was a
good investment of my
time.
*12. Overall, how satisfied were you with your experience as an advisor in the Media
Smart Youth Teen Leaders Program?
j Very Satisfied
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j Satisfied
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j Dissatisfied
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*13. What did you like best about being an advisor?
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*14. What did you like least about being an advisor?
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j Very Dissatisfied
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Successes and Challenges
*15. Please describe an instance when you felt your MediaSmart Youth program was
particularly successful.
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*16. What were your site’s biggest challenges with the MediaSmart Youth program?
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*17. What advice would you have for a future advisor in the MediaSmart Youth Teen
Leaders Program?
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18. Please tell us anything else you think is important to know about your experience with
the MediaSmart Youth Teen Leaders Program.
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| File Type | application/pdf |
| File Modified | 2015-02-05 |
| File Created | 2015-02-05 |