Suggested Demographic Questions with Questions (6/28/01)
Promoting Our Effectiveness in WIC!
6-Month Workshop Evaluation
This 6-month evaluation will help us assure that the workshop met our objectives. It is not an evaluation or test of you!
To help us maintain confidentiality and give you a unique identifier, please use the spaces below to record the first two letters of the month you were born, followed by the last two digits of the year you were born, and followed by the last four digits of your social security number
For example, if you were born in February of 1975 and your social security number was 999-99-1678, then you would record: F E 7 5 1 6 7 8.
Your unique identifier is:
___ ___ ___ ___ ___ ___ ___ ___
Promoting Our Effectiveness in WIC!
6-Month Workshop Evaluation
Please read each question carefully. Directions vary according to the question. Please remember to answer questions on both sides of the paper.
Please answer each of the following questions to help us assure that this workshop is designed to meet its objectives.
Section 1. Please answer each of the following questions to help us assure that the workshop met its objectives.
Rate how effective you are at work for each type of action. To record your answer, blacken the square that best describes you.
How effective are you at work in:
|Action |Effectiveness of the Workshop |
| |Not |Slightly |Moderately |Very |Extremely |
| 1. setting personal priorities |® |© |™ |∑ |⎛ |
| 2. accomplishing personal priorities. |® |© |™ |∑ |⎛ |
| 3. setting professional priorities. |® |© |™ |∑ |⎛ |
| 4. accomplishing professional priorities. |® |© |™ |∑ |⎛ |
| 5. accepting work responsibility. |® |© |™ |∑ |⎛ |
| 6. being accountable for what you do. |® |© |™ |∑ |⎛ |
|7. having a personal mission statement. |® |© |™ |∑ |⎛ |
|8. resolving conflicts |® |© |™ |∑ |⎛ |
|9. communicating clearly |® |© |™ |∑ |⎛ |
|10. using other people to identify alternative |® |© |™ |∑ |⎛ |
|solutions to problems. | | | | | |
Section 2. Looking back, rate how effective the workshop was in helping you to do each of the following actions. To record your answer, blacken the square that best describes the workshop’s effectiveness.
In relation to your job, how effective was the workshop in helping you to:
|Action |Effectiveness of the Workshop |
| |Not |Slightly |Moderately |Very |Extremely |
|11. prepare to significantly increase your |® |© |™ |∑ |⎛ |
|performance | | | | | |
|12. understand the basic principles underlying |® |© |™ |∑ |⎛ |
|personal effectiveness | | | | | |
|13. understand the basic principles underlying |® |© |™ |∑ |⎛ |
|interpersonal effectiveness | | | | | |
|14. develop your personal mission statement |® |© |™ |∑ |⎛ |
|15. understand how to communicate with others |® |© |™ |∑ |⎛ |
|effectively. | | | | | |
|16. prepare to work with others to influence |® |© |™ |∑ |⎛ |
|outcomes | | | | | |
17. Have you taken any actions at work as a result of participating in the workshop?
o Yes, I took some actions at work as a result of the workshop. Please continue with the next question.
o No, I did not take any actions at work as a result of the workshop. Thank you for completing this questionnaire. Please return it in the postage paid envelop provided.
18. Please identify any actions that you have taken at work as a result of participating in the workshop. (Please print your answer in the space provided.)
1.__________________________________________________________________________________________________________________________________________________________
2.__________________________________________________________________________________________________________________________________________________________
3.__________________________________________________________________________________________________________________________________________________________
4.__________________________________________________________________________________________________________________________________________________________
5.____________________________________________________________________________
Thank you for your time completing this questionnaire. Please return it in the postage-paid envelope provided.
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