Event Code




  


Last 4 digits of home phone number

CENTER FOR SUBSTANCE ABUSE PREVENTION TRAINING SYSTEMS (CTS)
SCBT CURRICULUM DESIGN AND DELIVERY PROCESS - STAGE II
PARTICIPANT PROFILE QUESTIONNAIRE



1. To what extent were you informed about the purposes of this workshop? Circle one number.

1
Not at all

 		2

 		 3

 		4

 		 5

 		6

 		 7

 		8

 		 9

 		10
Completely


2. To what extent did each of the following influence you to come to this workshop? Circle one number for each item.




a. General interest
b. Need to do your job or volunteer activities
differently
c. Required by organization to participate
d. Confirm what you are already doing is okay
e. Chance to network with others
f. Other:
please specify

 		No
Influence

1
1
1
1
1
1

 		2
2
2
2
2
2

 		3
3
3
3
3
3

 		4
4
4
4
4
4

 		Extremely
Influential

5
5
5
5
5
5


3. To what extent do you expect that this workshop will make a difference in the way you do your job or volunteer activities?

1
No
Difference

 		2

 		 3

 		4

 		 5

 		6

 		 7

 		8

 		 9

 		10
Substantial
difference


4. Please provide the following information about yourself:

a.

 		To what extent have you had previous training or education in substance abuse prevention?


 ~ Not at all

 		~ Very little

 		~ Some

 		~ A lot

 		~ Extensive


b.

 		To what extent have you worked or volunteered in the field of substance abuse prevention?


 ~ Not at all

 		~ Very little

 		~ Some

 		~ A lot

 		~ Extensive


c.

 		Which of the following is the primary focus of your substance abuse activities?


 ~ Prevention/education

 		~ Both prevention and treatment

 		 
 ~ Treatment/intervention

 		~ Other

 
    please specify

 


d.

 		Are you part of an organized prevention coalition or partnership in your community?


 ~ No

 		~ Yes


e.

 		Which type of organization are you primarily representing at this workshop? Please check the one best answer.


 ~ Government

 		~ Education

 		~ Not representing an organization
 ~ Law enforcement/legal

 		~ Religious

 		~ Other:

 ~ Hospital/health care

 		~ Volunteer organization

 		please specify
 ~ Private practice

 		~ Business

 		 


f.

 		Does anyone, other than yourself, expect something from you as a result of attending this workshop?


 ~ No
 ~ Yes: Please explain



g.

 		Did anyone accompany you to this workshop?


 ~ No, came alone

 		~ Yes, as part of a team
 ~ Yes, with others, but not as a team

~ Other:

  please specify


h.

 		How are your expenses for this workshop being paid?


 ~ By you

 		~ Shared between you and organization
 ~ By supporting organization, government, etc

 		~ Other: please specify



i.

 		Your sex: ~ Male ~ Female

j.

 		Your age: ~ 25 or less ~ 26-35 ~ 36-45 ~ 46-55 ~ over 55

k.

 		The highest level of formal education you have reached:
~ Grade school or some high school

 		~ College degree
~ Completed high school

 		~ Graduate school/graduate degree
~ Some college or a trade/vocational school

 		 


l. Based on the categories below, how would you identify your race or ethnicity?

~ African American

 		~ Caucasian

 		~ American Indian or Alaskan Native

~ Asian American or Pacific Islander

 		~ Hispanic/Latino

 		~ Other:
please specify


m.

 		Based on your answer to question "4-l" above, how do you further define your race or ethnicity?



5. Please circle the one number for each item, which most closely reflects your opinion:

a. I can identify effective curriculum design and delivery
skills.
b. I know how to acquire and practice curriculum design
skills.
c. I can recognize the value of a learner-centered
approach to developing curriculum design and delivery
skills.
d. I can explain the differences between what is
considered a behavioral approach to training and
learning process modele. I can identify areas of
curriculum design and delivery
skills development to continue improving.
f. I am currently using curriculum design and delivery
skills.

 		Strongly
Disagree
1

1

1

1


1

1

2

2

2

2


2

2

 		3

3

3

3


3

3

 		4

4

4

4


4

4

 		Strongly
Agree
5

5

5

5


5

5


6. Did you complete the pre-training materials? If not, please explain.

7. How much time did it take to read and complete the pre-training materials? Was sufficient time given?

8. How effective were the pre-training materials in preparing you for this training event?

9. What are your current level of skills in curriculum design and delivery?

10. General comments or suggestions.

 


Thank you


 


Event Code


 


 Last 4 digits of home phone number

CENTER FOR SUBSTANCE ABUSE PREVENTION TRAINING SYSTEMS (CTS)
SCBT CURRICULUM DESIGN AND DELIVERY PROCESS - STAGE III
PARTICIPANT FOLLOW-UP QUESTIONNAIRE



1. What are likely changes related to substance abuse prevention you may make in your job, organization or community, as a result of this workshop?

 


2. Overall, how would you rate the usefulness of this workshop? Circle one number.

1
Not at all

 		2

 		 3

 		4

 		 5

 		6

 		 7

 		8

 		 9

 		10
Completely


3. Overall, how would you rate the following about this workshop? Circle one number for each item.


a. Learning methods or processes
b. Organization, schedule, or flow of activities
c. Cultural competence* of workshop content and
process
d. Cultural competence* of trainers
e. Other:
please specify

* A set of academic and interpersonal skills that allow individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups.

Extremely
Poor
1
1
1

1
1

 		2
2
2

2
2

 		3
3
3

3
3

4
4
4

4
4

 		Excellent

5
5
5

5
5


4. To what extent did this workshop provide the following? Circle one number for each item.


a. Practical examples
b. Time for discussion
c. Practice time
d. Opportunity to consider what will help or stop
you from applying your learning
e. Help in preparing to apply learning
f. Other:
please specify

 		Not at all
1
1
1
1

1
1

 		2
2
2
2

2
2

 		3
3
3
3

3
3

 		4
4
4
4

4
4

 		Substantial
5
5
5
5

5
5


5. To what extent would you describe your experiences in this workshop as follows? Circle one number for each item.


a. Relevant to your job
b. Possible to apply
c. Better than what you are now doing
d. Met your needs
e. Met the needs of your organization/community
f. Other:
please specify

 		Not at all

1
1
1
1
1

 		2
2
2
2
2

 		3
3
3
3
3

 		4
4
4
4
4

 		Substantial

5
5
5
5
5


6. Overall, to what extent did the workshop lead to the following? Circle one number for each item.



a. Increased knowledge or skills
b. Encouraged links with others for support
c. Changed attitudes or feelings
d. Confirmed what you were already doing is okay
e. Offered insights into doing your job or volunteer
activities differently
f. Prepared you to apply learning
g. Other:
please specify

 		Not at all
1
1
1
1
1

1
1

 		2
2
2
2
2

2
2

 		3
3
3
3
3

3
3

 		4
4
4
4
4

4
4

 		Substantial
5
5
5
5
5

5
5


7. To what extent are you likely to do the following as a result of this workshop? Circle one number for each item.



a. Share information with others.
b. Make changes in how you do your work or
volunteer activities.
c. Use materials from the workshop
d. Contact others for support to apply learning
e. Actively encourage your organization to apply ideas
from the workshop
f. Get more training or information on topic
g. Increase substance abuse prevention activities
h. Other:
please specify

 		Not at all

1
1

1
1
1

1
1
1

 		2
2

2
2
2

2
2
2

 		3
3

3
3
3

3
3
3

 		4
4

4
4
4

4
4
4

 		Extremely

5
5

5
5
5

5
5
5


8. To what extent do you expect this workshop will make a difference in the way you do your job or volunteer activities?

1
Not at all

 		2

 		 3

 		4

 		 5

 		6

 		 7

 		8

 		 9

 		10
Substantial difference


9. To what extent do the following exist in your organization or community to help you apply your learning? Circle one number for each item.


a. Sufficient resources
b. Encouragement from others
c. Opportunity to apply learning
d. Authority to act or apply learning
e. Support for making changes suggested
during this workshop
f. Other:
please specify

 		Not at all
1
1
1
1
1

1

 		2
2
2
2
2

2

 		3
3
3
3
3

3

 		4
4
4
4
4

4

 		Substantial
5
5
5
5
5

5


10. To what extent do you feel able to apply your learning from this workshop to your job or volunteer activities? Circle one number.

1
Not at all

 		2

 		 3

 		4

 		 5

 		6

 		 7

 		8

 		 9

 		10
Completely


11. Please circle the one number for each item, which most closely reflects your opinion:



a. I can identify effective curriculum design and
delivery skills.
b. I know how to acquire and practice curriculum
design skills.
c. I can recognize the value of a learner-centered
approach to developing curriculum design and
delivery skills.
d. I can explain the differences between what is
considered a behavioral approach to training and
a learning process model.
e. I can identify areas of curriculum design and
delivery skills development to continue
improving.
f. I am currently using curriculum design and
delivery skills.

 		Strongly Disagree
1

1

1


1


1


1

 		2

2

2


2


2


2

 		3

3

3


3


3


3

 		4

4

4


4


4


4

 		Strongly
Agree
5

5

5


5


5


5



12. What State-level AOD prevention curriculum design and delivery teams are you actively involved in?

13. As a result of the training, what is your level of skills in curriculum design and delivery?

14. What progress have you made in implementing your action plan? Please explain.

15. Please add any additional comments or suggestions you have about the workshop or your experiences.

 











Thank you