End of Wave 1 Interview

End of Wave 1 Interview Questions – I Can Do It, You Can Do It!

Introductory Script:

Thank you for your involvement with the I Can Do It, You Can Do It! Program. This survey will collect feedback about your experience from start to finish with ICDI. The information gathered today will provide us with information that will be used to improve our programs in the future. Your feedback from this interview will be kept private to the extent permitted by law. I am required to inform you that according to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-XXXX. The time required to complete this information collection is estimated to average 30 minutes per response. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer.

Part I – Administrative/Confirmatory Information

1. Interview date:

2. Person conducting the interview:

3. Please confirm the following:

   1. Organization Represented:

   2. Interviewee's Name and Title:
      Email Address:

   3. Phone Number:

4. What was the start and end date of this most recent program wave? (confirm the number of weeks)

Start Date: End Date: Number of Weeks:

Part II –Wave Specific Information

Section I: Participants

5. Can you describe the population your ICDI program served?

6. How many mentees participated in the full 8-week program during Wave 1?

7. How many mentors participated in the full 8-week program during Wave 1?

8. What sort of experience did you have related to mentor/mentee dropout?

9. Did your organization use the PALA+ Goal Resources and Awards during this wave?

   1. If yes, how many PALA+ Awards did your mentees earn during Wave 1?

   2. If no, why did you choose not to use the PALA+ Goal Resources and Awards?

Section II: Recruitment

10. How did you recruit mentors and mentees?

11. What suggestions would you recommend to help schools or organizations recruit mentors and mentees with and without disabilities in the future?

Section III: Program Activities and Location

12. Please describe your program in detail.

    1. What kinds of physical activities were included in your sessions?

    2. What type of facilities did you use during the wave?

    3. What type of healthy eating activities or lessons did you include in Wave 1?

13. To what extent did the setting (e.g. community-based; school based) impact your implementation of the program? Advantages? Disadvantages?

Section IV: Partners

14. What organizations did you partner with during Wave 1? What type of assistance did these partners provide?

15. What are your strategies for securing funding in the future?

Section V: Outcomes

16. What were the greatest challenges you encountered during this wave of the program?

17. What did you learn from these challenges?

18. How will your lessons learned from this wave impact your actions moving into wave 2?

19. What is the best outcome / highlight of Wave 1 of your ICDI program?

Section VI: Costs and Time Use

20. You received $X,000 to implement an ICDI program at your site and support evaluation of ICDI overall. How much of the incentive did you use for the following? Please be as precise as possible.

Spending Category	Amount (in dollars)
Salaries and Staffing
Equipment
Facilities
Additional Training
Transportation
Outside Activities
Other

21. Did you receive any in-kind support to implement ICDI during this program wave (e.g. space, labor, etc.)?

1. If Yes: What type of in-kind support did you receive during this program wave? What was the value in dollars of the support?

Spending Category	Amount (in dollars)
Salaries and Staffing
Equipment
Facilities
Additional Training
Transportation
Outside Activities
Other

22. Do you feel the amount you received was appropriate to support the implementation of ICDI at your site during this program wave?