Healthy Native Youth Feedback Form Thank you! Many thanks for requesting technical assistance, attending our training, and/or participating in our Community of Practice. We would like to hear whether it was helpful for you, and how we can support other trainees or interested educators. We appreciate your feedback! The survey will take approximately 10 minutes to complete. Question Title * 1. First and Last Name: (optional) Question Title * 2. Tribe or Organization: Question Title * 3. What state do you live in? Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia (DC) Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Question Title * 4. If you live outside the U.S., what country do you live in? Question Title * 5. Phone or Cell Phone: Question Title * 6. What is your email address: Question Title * 7. What Healthy Native Youth (HNY) activity did you participate in? (select all that apply) Received Technical Assistance (via phone, email, or in-person) Attended an in-person Training or Workshop Attended a virtual Training (webinar or Community of Practice) Visited the HNY website Used a HNY Curriculum Used a HNY Stand-alone Lesson Used the HNY Implementation Toolbox What training or CoP did you attend? (please describe) Question Title * 8. How likely are you to use the information you acquired from the website, during the training, and/or from the TA we provided? Very likely Somewhat likely Not very likely Question Title * 9. How would you rate the quality of the curriculum, training, and/or technical assistance (TA) that you received from Healthy Native Youth? 0 - Poor Neutral 10 - Excellent Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 10. How would you rate the cultural-relevance and/or fit of the curriculum, training, and/or TA that you received from Healthy Native Youth? 0 - Poor Neutral 10 - Excellent Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 11. How were the materials received by your students and/or community partners? 0 - Not well received Neutral 10 - Very well received Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 12. What impact has the Healthy Native Youth’s website, trainings, and/or other resources had on you and your community? (check all that apply) It has increased access to culturally-relevant health education materials for youth in my community It has improved access to age-appropriate health resources for youth and young adults in my community It has provided me with easy-to-use templates that can be used to improve adolescent health in my community It has improved my access to culturally relevant professional development trainings and a community of support It has provided me with relatable tips and examples on how to deliver adolescent health programs in my community Other: (please describe) Question Title * 13. In the last year, have you implemented any HNY curricula? (check all that apply) No Yes – Mind4Health Training Yes – BRAVE Yes – Native It’s Your Game 2.0 (NIYG) Yes – Native STAND (original) or Native STAND 2.0 Yes – We Are Here Now Yes – Safe in the Village Yes – Native VOICES Yes – Healing of the Canoe Yes – Youth Spirit Program Yes – Respecting the Circle of Life Yes – First Nations Youth Suicide Prevention Curriculum Yes – Bounce Back for Classrooms Yes – Native SISTERS Yes – Gender Matters for Native Youth (GEN-M Native) Yes – Multimedia Circle of Life (mCOL) Yes – We R Native Teacher’s Guide Yes – Ogitchidag Gikinooamaagad Peer Education Yes – Responding to Concerning Posts on Social Media Other: (please describe) Question Title * 14. If yes, how many students attended the program: Question Title * 15. Where have you used HNY’s curricula, lesson plans, and/or Implementation Toolbox templates? (check all that apply) Not applicable During school After school At a community event At a cultural event Somewhere else: (please describe) Question Title * 16. Did you make any changes, enhancements, or adaptations to the materials? No Not applicable Yes, please describe: (optional) Question Title * 17. As you think about the phases in the HNY Implementation Toolbox, what phase most closely describes the type of work you are doing right now? Gather Phase: We are gathering our community together to get their guidance and feedback. Choose Phase: We are selecting a culturally-relevant health program and getting approval if needed. Prepare Phase: We are preparing to deliver the selected program – gathering supplies, ordering materials, and previewing the lessons. Implement Phase: We are implementing the program and celebrating the journey. Grow Phase: We are reflecting on last year’s delivery and planning for next year. Not applicable Other: (please describe) Question Title * 18. In the last year, have you used any of HNY’s Implementation Toolbox tools or templates? (check all that apply) No Not Applicable Yes – Template: Identify Youth Advocates and Community Partners Yes – Template: Community Needs and Resource Assessment Yes - Template: Implementation Action Plan Yes – Activity Guide: Bingo Data Collection Activity Yes – Template: Program Selection Checklist Yes – Template: Letter of Support (for educator & site) Yes – Template: Letter for Parents and Guardians Yes – Examples: Recruitment flyers, news articles, parent and youth cover letters Yes – Example: List of Training Materials Yes – Template: Session Reflection Log Yes – Other: (please describe) Question Title * 19. Do you have any additional feedback or changes you would recommend to help improve the HNY website, technical assistance, templates, or trainings? Question Title * 20. Do you have a quote or story to share? Do you have a reflection, memory, or story about the HNY website and its resources? Please share your reflection/memory in the box below.For Example: What makes HNY stand out as a resource? What do people need to know about HNY? What difference has the HNY website and TA made to your work?We love to share quotes from those who have successfully used the HNY website or its resources. Question Title * 21. May we share your feedback on the www.HealthyNativeYouth.org website? Yes No Thanks for all that you do to raise Healthy Native Youth! Done
