336-001 Series POST-CdSrAmb-Individual Survey (8/13) POST

1. POST Data Entry

Data entry instructions - Please assign a unique number to EACH completed survey record before beginning. This will assist us if we need to track a particular answer to the original survey.

In addition, you may notice that your region's version of the survey may not ask an item. If your region's participants have not been asked about an item or if it is blank, just leave the response blank.

Please verify that this is NOT a "Pre" survey.

Thank you!

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* Survey ID#

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* Age level:

Cadette

Senior

Ambassador

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* Grade

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* Date (Please use numbers. November 12, 2008 = 11/12/2008)

(This is the date that the participant responded to the survey.)

Today's date

Date

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* Middle Initial, Favorite animal? (compares pre/post)

Middle initial @post

Favorite animal @post

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* Special topic? (drop down menu)

Other (please specify)

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* Meeting Place:

Other (please specify)

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* Region

Cincinnati

Dayton

Lima

Toledo

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* Pre? or Post? (All should be POST.)

Opening Survey (pre)

Closing Survey (post)

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* Type of Series?

In-school

Community Collaboration

Volunteer-Led

Camp

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* County (Data entry: Please enter the county where the meeting place is located.)

Allen

Auglaize

Brown

Butler

Champaign

Clark

Clermont

Clinton

Darke

Defiance

Fulton

Greene

Hamilton

Hancock

Hardin

Henry

Logan

Lucas

Mercer

Miami

Montgomery

Ottawa

Paulding

Preble

Putnam

Sandusky

Seneca

Shelby

Van Wert

Warren

Williams

Wood

Other (please specify)

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* United Way?
(Please use drop-down menu.)

Ask staff if you don't know.

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* Special funder or grant?
If yes, please describe. (See list below.)

Ask staff if you don't know.

Yes

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* Special Funder or Grant Name?

Other (please specify)

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* How often do you …?

	1 Never	2 Hardly ever	3 Sometimes	4 A lot of the time	5 Always	? Not sure or don't want to say
When I am with younger kids, I set a good example by choosing healthy snacks (like fruits and vegetables). @post	When I am with younger kids, I set a good example by choosing healthy snacks (like fruits and vegetables). @post 1 Never	When I am with younger kids, I set a good example by choosing healthy snacks (like fruits and vegetables). @post 2 Hardly ever	When I am with younger kids, I set a good example by choosing healthy snacks (like fruits and vegetables). @post 3 Sometimes	When I am with younger kids, I set a good example by choosing healthy snacks (like fruits and vegetables). @post 4 A lot of the time	When I am with younger kids, I set a good example by choosing healthy snacks (like fruits and vegetables). @post 5 Always	When I am with younger kids, I set a good example by choosing healthy snacks (like fruits and vegetables). @post ? Not sure or don't want to say
I like to try new things, even if I might not do too well at first.@post	I like to try new things, even if I might not do too well at first.@post 1 Never	I like to try new things, even if I might not do too well at first.@post 2 Hardly ever	I like to try new things, even if I might not do too well at first.@post 3 Sometimes	I like to try new things, even if I might not do too well at first.@post 4 A lot of the time	I like to try new things, even if I might not do too well at first.@post 5 Always	I like to try new things, even if I might not do too well at first.@post ? Not sure or don't want to say
I set goals for myself to achieve. @post	I set goals for myself to achieve. @post 1 Never	I set goals for myself to achieve. @post 2 Hardly ever	I set goals for myself to achieve. @post 3 Sometimes	I set goals for myself to achieve. @post 4 A lot of the time	I set goals for myself to achieve. @post 5 Always	I set goals for myself to achieve. @post ? Not sure or don't want to say
Before I make a final decision, I think about all of my options. @post	Before I make a final decision, I think about all of my options. @post 1 Never	Before I make a final decision, I think about all of my options. @post 2 Hardly ever	Before I make a final decision, I think about all of my options. @post 3 Sometimes	Before I make a final decision, I think about all of my options. @post 4 A lot of the time	Before I make a final decision, I think about all of my options. @post 5 Always	Before I make a final decision, I think about all of my options. @post ? Not sure or don't want to say
I work well with others as a team. @post	I work well with others as a team. @post 1 Never	I work well with others as a team. @post 2 Hardly ever	I work well with others as a team. @post 3 Sometimes	I work well with others as a team. @post 4 A lot of the time	I work well with others as a team. @post 5 Always	I work well with others as a team. @post ? Not sure or don't want to say
When I read or hear about other people’s problems, I think of ways I can help. @post	When I read or hear about other people’s problems, I think of ways I can help. @post 1 Never	When I read or hear about other people’s problems, I think of ways I can help. @post 2 Hardly ever	When I read or hear about other people’s problems, I think of ways I can help. @post 3 Sometimes	When I read or hear about other people’s problems, I think of ways I can help. @post 4 A lot of the time	When I read or hear about other people’s problems, I think of ways I can help. @post 5 Always	When I read or hear about other people’s problems, I think of ways I can help. @post ? Not sure or don't want to say
I ask others for help when I need it. @post	I ask others for help when I need it. @post 1 Never	I ask others for help when I need it. @post 2 Hardly ever	I ask others for help when I need it. @post 3 Sometimes	I ask others for help when I need it. @post 4 A lot of the time	I ask others for help when I need it. @post 5 Always	I ask others for help when I need it. @post ? Not sure or don't want to say
When I see someone being picked on, I try to help. @post	When I see someone being picked on, I try to help. @post 1 Never	When I see someone being picked on, I try to help. @post 2 Hardly ever	When I see someone being picked on, I try to help. @post 3 Sometimes	When I see someone being picked on, I try to help. @post 4 A lot of the time	When I see someone being picked on, I try to help. @post 5 Always	When I see someone being picked on, I try to help. @post ? Not sure or don't want to say
I speak up for what is right, even if it is not popular.@post	I speak up for what is right, even if it is not popular.@post 1 Never	I speak up for what is right, even if it is not popular.@post 2 Hardly ever	I speak up for what is right, even if it is not popular.@post 3 Sometimes	I speak up for what is right, even if it is not popular.@post 4 A lot of the time	I speak up for what is right, even if it is not popular.@post 5 Always	I speak up for what is right, even if it is not popular.@post ? Not sure or don't want to say

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* How much do you AGREE...

	1 Disagree a lot	2 Disagree a little	3 Agree a little	4 Agree a lot	? Not sure or don't want to say
To make others like me, I sometimes do things that I know are wrong. @pre	To make others like me, I sometimes do things that I know are wrong. @pre 1 Disagree a lot	To make others like me, I sometimes do things that I know are wrong. @pre 2 Disagree a little	To make others like me, I sometimes do things that I know are wrong. @pre 3 Agree a little	To make others like me, I sometimes do things that I know are wrong. @pre 4 Agree a lot	To make others like me, I sometimes do things that I know are wrong. @pre ? Not sure or don't want to say
I try to talk problems out calmly instead of yelling. @post	I try to talk problems out calmly instead of yelling. @post 1 Disagree a lot	I try to talk problems out calmly instead of yelling. @post 2 Disagree a little	I try to talk problems out calmly instead of yelling. @post 3 Agree a little	I try to talk problems out calmly instead of yelling. @post 4 Agree a lot	I try to talk problems out calmly instead of yelling. @post ? Not sure or don't want to say
I really like who I am, no matter what other people think. @post (optional-Dayton use)	I really like who I am, no matter what other people think. @post (optional-Dayton use) 1 Disagree a lot	I really like who I am, no matter what other people think. @post (optional-Dayton use) 2 Disagree a little	I really like who I am, no matter what other people think. @post (optional-Dayton use) 3 Agree a little	I really like who I am, no matter what other people think. @post (optional-Dayton use) 4 Agree a lot	I really like who I am, no matter what other people think. @post (optional-Dayton use) ? Not sure or don't want to say
I think that learning new things is always fun. @post (optional- Toledo use)	I think that learning new things is always fun. @post (optional- Toledo use) 1 Disagree a lot	I think that learning new things is always fun. @post (optional- Toledo use) 2 Disagree a little	I think that learning new things is always fun. @post (optional- Toledo use) 3 Agree a little	I think that learning new things is always fun. @post (optional- Toledo use) 4 Agree a lot	I think that learning new things is always fun. @post (optional- Toledo use) ? Not sure or don't want to say

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* How much LIKE YOU is...?

	1 Not at all like me	2 Not much like me	3 A little like me	4 A lot like me	? Not sure or don't want to say
I like being a girl.@post	I like being a girl.@post 1 Not at all like me	I like being a girl.@post 2 Not much like me	I like being a girl.@post 3 A little like me	I like being a girl.@post 4 A lot like me	I like being a girl.@post ? Not sure or don't want to say
If I get into an argument with friends, I am able to think of more than one way to make things better.@post	If I get into an argument with friends, I am able to think of more than one way to make things better.@post 1 Not at all like me	If I get into an argument with friends, I am able to think of more than one way to make things better.@post 2 Not much like me	If I get into an argument with friends, I am able to think of more than one way to make things better.@post 3 A little like me	If I get into an argument with friends, I am able to think of more than one way to make things better.@post 4 A lot like me	If I get into an argument with friends, I am able to think of more than one way to make things better.@post ? Not sure or don't want to say
I look for ways to meet kids who are from cultures different than mine.@post	I look for ways to meet kids who are from cultures different than mine.@post 1 Not at all like me	I look for ways to meet kids who are from cultures different than mine.@post 2 Not much like me	I look for ways to meet kids who are from cultures different than mine.@post 3 A little like me	I look for ways to meet kids who are from cultures different than mine.@post 4 A lot like me	I look for ways to meet kids who are from cultures different than mine.@post ? Not sure or don't want to say
I am able to get others to take action when a problem arises in my community.@post	I am able to get others to take action when a problem arises in my community.@post 1 Not at all like me	I am able to get others to take action when a problem arises in my community.@post 2 Not much like me	I am able to get others to take action when a problem arises in my community.@post 3 A little like me	I am able to get others to take action when a problem arises in my community.@post 4 A lot like me	I am able to get others to take action when a problem arises in my community.@post ? Not sure or don't want to say

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* Have you felt welcomed by adults to GS activities?

Yes @post

No @post

Maybe @post

If YES, where? when?

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* Have you participated in Girl Scout activities before?

Yes

Don't know

If YES, where? when?

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* I can't wait to (@post) " ____________________"

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* In this Girl Scout experience, I was able to do things I could not do in other places.

Yes

Maybe

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* What makes you feel best about GS program activities?

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* What could we do to make the program activities better?

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* What could be done to make things better?

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* WHO is the adult with you at GS activities?

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* Would you participate again in GS activities?

Yes @post

No @post

Maybe @post

Don't know @post

If YES, where? when?

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* Would you recommend GS activities to a friend?

Yes @post

No @post

Maybe @post

Don't know @post

If YES, where? when?

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* [required in Cincinnati- enter other regions' data if provided]
In each week, how many weekdays (Mon-Fri) are you involved in activities such as GS, sports, clubs, other organizations or lessons in "after-school hours" before 6pm?

no days

1 day

2 days

3 days

4 days

5 days

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* Other comments...

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* Originator of data entry work order (name of staff member)

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* Work Order# ("336-_ _ _ - r _ _")

Thank you.

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* Survey ID#

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* Age level:

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* Grade

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* Date (Please use numbers. November 12, 2008 = 11/12/2008)(This is the date that the participant responded to the survey.)

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* Middle Initial, Favorite animal? (compares pre/post)

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* Special topic? (drop down menu)

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* Meeting Place:

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* Region

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* Pre? or Post? (All should be POST.)

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* Type of Series?

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* County (Data entry: Please enter the county where the meeting place is located.)

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* United Way?(Please use drop-down menu.)Ask staff if you don't know.

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* Special funder or grant?If yes, please describe. (See list below.)Ask staff if you don't know.

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* Special Funder or Grant Name?

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* How often do you …?

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* How much do you AGREE...

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* How much LIKE YOU is...?

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* Have you felt welcomed by adults to GS activities?

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* Have you participated in Girl Scout activities before?

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* I can't wait to (@post) " ____________________"

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* In this Girl Scout experience, I was able to do things I could not do in other places.

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* What makes you feel best about GS program activities?

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* What could we do to make the program activities better?

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* What could be done to make things better?

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* WHO is the adult with you at GS activities?

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* Would you participate again in GS activities?

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* Would you recommend GS activities to a friend?

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* [required in Cincinnati- enter other regions' data if provided]In each week, how many weekdays (Mon-Fri) are you involved in activities such as GS, sports, clubs, other organizations or lessons in "after-school hours" before 6pm?

Question Title

* Other comments...

Question Title

* Originator of data entry work order (name of staff member)

Question Title

* Work Order# ("336-_ _ _ - r _ _")

* Date (Please use numbers. November 12, 2008 = 11/12/2008)

(This is the date that the participant responded to the survey.)

* United Way?
(Please use drop-down menu.)

Ask staff if you don't know.

* Special funder or grant?
If yes, please describe. (See list below.)

Ask staff if you don't know.

* [required in Cincinnati- enter other regions' data if provided]
In each week, how many weekdays (Mon-Fri) are you involved in activities such as GS, sports, clubs, other organizations or lessons in "after-school hours" before 6pm?