Evaluation of Technical Assistance Services Question Title * 1. Name of Child Care Program? Question Title * 2. Name of person completing survey? Question Title * 3. Name of Technical Assistance Specialist who provided the services? Question Title * 4. Dates Technical Assistance was received? (Does not have to be exact. If only month and year are known, put "1" as the day.) Start Date: Date End Date: Date Question Title * 5. Number of visits received? 1-2 visits 3-6 visits 7-10 visits 11 or more visits Question Title * 6. Rate the TA Specialist/Service as follows: (5 is highest, Strongly Agree and 1 is the lowest, Strongly Disagree) 5 4 3 2 1 The TA Specialist was knowledgeable The TA Specialist was knowledgeable 5 The TA Specialist was knowledgeable 4 The TA Specialist was knowledgeable 3 The TA Specialist was knowledgeable 2 The TA Specialist was knowledgeable 1 The TA Specialist was able to assist me in finding additional resources if needed (programs, people, materials) The TA Specialist was able to assist me in finding additional resources if needed (programs, people, materials) 5 The TA Specialist was able to assist me in finding additional resources if needed (programs, people, materials) 4 The TA Specialist was able to assist me in finding additional resources if needed (programs, people, materials) 3 The TA Specialist was able to assist me in finding additional resources if needed (programs, people, materials) 2 The TA Specialist was able to assist me in finding additional resources if needed (programs, people, materials) 1 The service was clearly explained to me The service was clearly explained to me 5 The service was clearly explained to me 4 The service was clearly explained to me 3 The service was clearly explained to me 2 The service was clearly explained to me 1 Overall rating of your experience Overall rating of your experience 5 Overall rating of your experience 4 Overall rating of your experience 3 Overall rating of your experience 2 Overall rating of your experience 1 Question Title * 7. What did you like most about participating in the Technical Assistance? Question Title * 8. What did you like the least about the Technical Assistance? Question Title * 9. Do you feel the quality of your classroom has improved as a result of the Technical Assistance? Yes No Not Sure Why or why not? Question Title * 10. Would you recommend this service to another provider? Yes No Not Sure Why or why not? Question Title * 11. Would you contact the TA Specialist for questions/TA in the future? Yes No Question Title * 12. Please list specific recommendations to improve the quality of service provided through the Technical Assistance? Done
