SPNS COOPERATIVE AGREEMENT EVALUATION

MODULE 6: TECHNICAL ASSISTANCE EVALUATION FORM INSTRUCTIONS

Citation: Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1995). Module 6: Technical Assistance Evaluation Form. Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.

Answer questions by either filling in a circle, or writing a number or letter in a square box. If the answer goes in a square box, you must use a CAPITAL LETTER or number that does not touch the side of the box. Print only one letter or number in each box. If the letters or numbers that you print touch the sides of the boxes, or if you do not clearly print the information, the computer will "kick out" the form and we will need to return it to you to be completed correctly. If the question asks the answer to be filled in a circle, make sure that the circle is completely darkened. Only darken one circle for each question unless the instructions specifically tell you to darken as many as apply for that question.

NOTE: Before giving the form to the trainee, site staff should complete the information in the shaded boxes. These boxes include "Site," "Sub-Provider," "Technical Assistance Date," "Hour," "Length in Minutes," "Staff Code" and "Name of Staff."

Specific Parts of Module 6: Technical Assistance Evaluation Form

Site. This is a code to identify your project in the cross-cutting evaluation. It should be pre-printed on the form. If it has not been already entered on the form, check with your project to find out your site code and enter it in the boxes. Site codes are 3 letters.

Sub-Provider. If appropriate, enter the code for the service provider agency doing the activity. The provider codes are determined by your local project. Provider codes can be up to 3 letters.

Technical Assistance Date. Enter the numbers representing the date of the technical assistance in these boxes. Enter the month as a number from 01 to 12 for January through December. Enter the day as a two-digit number (01 to 31). Enter the last two digits of the current year (for example, "96" for 1996). Make sure that if a month or day is less than 10, you place a "0" before the number.

Hour. Enter the starting time of the technical assistance as a two-digit number. Round to the nearest hour. For example, if the start time is between 10:31 am and 11:30 am you would enter "11" in the boxes and darken the circle labeled "am."

Length In Minutes. Enter the length of time of the technical assistance as a three-digit number. For example, if the length of time of the technical assistance is 90 minutes, you would enter "090."

Staff Code. Enter the code for the staff person providing this technical assistance. The staff codes are determined by your local project. If the staff code is less than 3 digits, place "0"s before the number. For example, 3 is "003."

Name of Staff. In the boxes provided, enter the name of the staff person who provided technical assistance.

How would you rate your level of knowledge about this topic before technical assistance was provided? Darken the circle next to "Novice/Beginner" if you knew nothing or almost nothing about the topic before technical assistance was provided. Darken the circle next to "Slightly Knowledgeable" if you knew a little about the topic before technical assistance was provided. Darken the circle next to "Somewhat Knowledgeable" if you were pretty well acquainted with the topic before technical assistance was provided. Darken the circle next to "Very Knowledgeable" if you were very well acquainted with the topic before technical assistance was provided. Darken the circle next to "Expert," if you were extremely knowledgeable about the topic before technical assistance was provided.

How would you rate the quality of the technical assistance (e.g. clarity of presentation, content of material)? Darken the circle next to the response which most adequately describes how you would rate the quality of the technical assistance. Darken the circle next to "Poor" to rate the quality as poor, darken the circle next to "Fair" to rate the quality as fair, darken the circle next to "Good" to rate the quality as good, darken the circle next to "Very Good" to rate the quality as very good, or darken the circle next to "Excellent" to rate the quality as excellent.

How would you rate the usefulness of the technical assistance for your work? Darken the circle next to the response which most adequately describes how you would rate the usefulness of the technical assistance for your work. Darken the circle next to "Poor" to rate the usefulness as poor, darken the circle next to "Fair" to rate the usefulness as fair, darken the circle next to "Good" to rate the usefulness as good, darken the circle next to "Very Good" to rate the usefulness as very good, or darken the circle next to "Excellent" to rate the usefulness as excellent.

How would your rate the scope and depth of the technical assistance? Darken the circle next to "Much Too Complex" if you feel the scope and depth went far beyond what was necessary for your understanding of the topic. Darken the circle next to "Too Complex" if you feel that the technical assistance was a little too in-depth for you. Darken the circle next to "About Right" if you feel that the technical assistance was just about right for your needs. Darken the circle next to "Too Simple" if you feel that the technical assistance was a little too simple for you. Darken the circle next to "Much Too Simple" if you feel that the technical assistance was far too simple for your needs.

Was the technical assistance worth your time and effort? Darken the circle next to "Yes" if you feel that the technical assistance was worth your time and effort to attend. Darken the circle next to "No" if you feel that the technical assistance was not worth your time. If you are unsure, darken the circle next to "Not Sure."

Would you recommend a similar type of technical assistance to a peer? Darken the circle next "Yes" if you would recommend a similar type of technical assistance to a peer. Darken the circle next to "No" if you would not recommend a similar type of technical assistance. If you are unsure, darken the circle next to "Not Sure."

Comments and suggestions for future technical assistance: In the space provided please write in your comments and suggestions for future technical assistance.