2012 Evaluation Workshop at Montclair State University Survey

1. Registrant Information:

Registrant Information: Name:
Organization Name:
Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

*

2. My job title is:

My job title is:

3. Which of the following describes the evaluation carried out by your organization? (check all that apply)

Which of the following describes the evaluation carried out by your organization? (check all that apply) Not sure what kinds of evaluation my organization does

We do not do formal evaluation of our programs

We collect limited data to monitor programs and services

We collect data to determine program outcomes

We have engaged in rigorous evaluation studies to determine program effectiveness

Other (please specify)

4. Does your job require you to conduct program evaluation?

Does your job require you to conduct program evaluation? No

Yes, with minor evaluation responsibility

Yes, with major evaluation responsibility

If Yes, please specify

5. Are you in a position to determine whether and what kind of evaluation will be conducted within your organization (which may include determining allocation of resources to evaluation)?

Are you in a position to determine whether and what kind of evaluation will be conducted within your organization (which may include determining allocation of resources to evaluation)? I am not sure

No

Yes (please describe your role)

6. How would you characterize your evaluation background?

How would you characterize your evaluation background? Novice (have only heard about evaluation-related terms)

Informal training in evaluation related areas (e.g., workshops/conference)

Experiential training in evaluation related areas (e.g. on-the-job)

Formal training in evaluation related areas (e.g. college/university)

7. What is your primary goal in attending this conference (i.e. what are you hoping to gain?)

What is your primary goal in attending this conference (i.e. what are you hoping to gain?)

8. Is there anything else you’d like us to know?

Is there anything else you’d like us to know?

*

9. Are you an alumnus of Montclair State University?

Are you an alumnus of Montclair State University? Yes

No

10. If Yes, please indicate the most recent year you graduated and your program/major.

If Yes, please indicate the most recent year you graduated and your program/major. Year of Graduation
Major or Program

BEFORE HITTING THE "NEXT" BUTTON BELOW, PLEASE PRINT OUT THIS PAGE SO THAT YOU MAY MAIL THE PRINTOUT TO COMPLETE YOUR REGISTRATION.

Please include a check or money order (see fee schedule below) made payable to Montclair State University and mail to:

Ms. Tina Seaboch
Center for Research & Evaluation on Education and Human Services
UN3124
Montclair State University
1 Normal Avenue
Montclair, NJ 07043

Forms and payment must be postmarked NO LATER THAN September 25, 2012. If you have any questions, please email Ms. Seaboch at seabocht@mail.montclair.edu

WORKSHOP FEE SCHEDULE (includes tuition, materials, continental breakfast, lunch, and parking):

Postmarked by August 30:
$200 individual registration
$125 for each additional individual from the same organization

Postmarked between August 31 and September 25:
$ 250 individual registration
$150 for each additional individual from the same organization

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