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Small Steps to Health and Wealth Overall Program Evaluation

This evaluation is for the Small Steps to Health and Wealth program you participated in. Your responses will help us improve its quality and make it better for others. There are no known risks in completing this survey, however, for any reason, you may choose not to answer any question, or not answer this survey at all. Not completing this survey or the way by which you answer the questions will not affect your relationship with UNL Extension, UNL, or any of the specific people who are running this program. It will take between 10 and 20 minutes to complete this evaluation.

We are not asking for your name so your responses are completely confidential. Your specific answers to this survey will be combined with those of others and only averages and trends will be reported – not your specific answers. Those data may be placed in reports or articles that describe how well this and other Extension programs are working.

If you have any questions or concerns that have not been addressed, please contact: Lisa Franzen (phone: 308-632-1256, email:lfranzen2@unl.edu), who is overseeing this evaluation. You may also contact the UNL Institutional Review Board at (402) 472-6965.

* 1. Location (what county do you live in)?

* 2. How many weeks did you stay in the program?

* 3. How did you participate in the program?

* 4. Did you participate in the SSHW Challenge, where you tracked points for health and financial behaviors?

* 5. If you did participate in the SSHW Challenge, please rate your experience. Only select one of the following choices that best fits your experience.

* 6. How much did you weigh (in pounds) when you started the program?

* 7. How much did you weigh (in pounds) at the end of the program?

* 8. How tall are you (in feet and inches)?

* 9. Please enter your age.

* 10. Gender

* 11. What is your marital status?

* 12. Which of the following best describes you? (Choose all that apply)

* 13. Which best describes your situation?

* 14. Do you currently work?

* 15. Please tell us about your experience in this program:

  Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree
The program gave me information that was useful
The program was up-to-date
The materials (e.g., hand-outs) for this program were of high quality
The instructors communicated well
The instructors were well-prepared
The instructors motivated me to think about the topic and how it applies to my life
I learned something worthwhile in this program
I would recommend this program to others
As a result of this program, I believe that I will make changes and improvements in my life

* 16. Please select the following behavior changes that apply to you (i.e. you can report on as many as you experienced) as a result of your participation:

* 17. Please list new ideas you learned or ideas that were reinforced due to attending this program.

* 18. What changes do you plan to make based upon what you learned at this program?

* 21. In order to spread the word about University of Nebraska Extension programs like the one you attended, we like to use quotes from program participants in future advertisements. You might think of what you’d say to a friend if recommending this program. If you have a quote you would like to share please put it below and type your name indicating your permission to use the statement and your name for future advertising. No name will indicate the statement may be used but without source.

* 22. If you would like to be considered for the $25.00 visa card drawing please provide your first and last name in the blank below.