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First Name

Last Name

Title

Company*

City*

Email*

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1.	Which Discovery Dating Teacher Training did you attend?

	Red Lake, MN
	Green Bay, WI (CEC Building)
	Green Bay, (Golden House)
	Appleton (Harbor House)
	Green Bay and Appleton (Golden House & Harbor House)

2.	Why did you attend this training?

	(Select all that apply.)
	Mandatory or required training
	Interested in subject
	Career advancement
	Learn additional skills
	Networking
	Other:

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3.	How often do you use Discovery Dating?

	Frequently
	Sometimes
	Once in a while
	Once or twice
	Never

4.	What do you remember about Discovery Dating?

5.	How have you applied the Discovery Dating program in your work?

	I used it with my classes and/or afterschool groups.
	I use it with my groups.
	I use it with my clients in a one-on-one situation.
	I use it at home with my children.
	I use it for myself.
	Other:

6.	What parts of Discovery Dating do you find the most helpful?

	(Select all that apply.)
	Diary sheets
	Pyramid sheets
	Key cards
	Script dates
	Dreams & Goals activity
	Temporary vs. Permanent chart
	Pitfalls & Benefits chart
	Mentoring activities
	My Ideal Island activity
	Key Encounters

7.	Do you consider Discovery Dating as a primary teen dating violence or pregnancy prevention tool?

	Yes - teen dating violence prevention
	Yes - teen pregnancy prevention
	Yes - both
	No - both

8.	How do you use Discovery Dating as a primary teen dating violence or teen pregnancy prevention tool?

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9.	Subject matter

	It was new information to me.
	It was very interesting.
	It was appropriate and timely.
	It wasn't what I thought it was.
	It didn't relate to me or my program.

10.	Teaching style

	I enjoyed the way the class was taught.
	I thought the instructors did a good job with a few concerns.
	I had a hard time following what was being taught.
	I didn't enjoy the way the class was taught.

11.	Materials handed out at the training:

	They were great: understandable, easy to use and allow creativity.
	They were useful: understandable and easy to use.
	They were helpful.
	They were fine but needed more instruction on how to use them.
	They were okay at the training, but I haven't used them since.

12.	Follow-up from instructors

	The checking in helped me a lot and I appreciated it.
	The follow-up helped get me on the right path to using the training.
	The follow-up didn't help me at all.
	There was no checking in.

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13.	How often do you visit our web site?

	I didn't know there was a website.
	Daily
	Weekly
	Monthly
	Once in a while
	Once

14.	Rate your satisfaction with our web site.

	Very satisfied
	Satisfied
	Neither
	Somewhat dissatisfied
	Dissatisfied

15.	What are you suggestions for improving this web site?

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16.	The information you learned via this training was valuable.

	Strongly agree
	Agree
	Neither
	Disagree
	Strongly disagree

17.	How would you rate your overall satisfaction with the training?

	Very satisfied
	Satisfied
	Neither
	Dissatisfied
	Very dissatisfied

18.	How likely are you to attend another training session?

	Very likely
	Likely
	Neither
	Unlikely
	Very unlikely

19.	How likely are you to recommend this training to others?

	Very likely
	Likely
	Neither
	Unlikely
	Very unlikely

20.	What are you suggestions for improving this training?

21.	Which of these other events are you aware of?

	(Select all that apply.)
	Discovery Dating Teacher Training Refresher cost
	Discovery Dating website Teacher Page
	Updated and revised Discovery Dating Teacher Manual
	ToP Group Facilitation Methods Training offered by Wise Women Gathering Place
	ToP Participatory Strategic Planning Training offered by Wise Women Gathering Place

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22.	What is your age?

	18-21
	22-29
	30-39
	40-49
	50-59
	60+

23.	What is your gender?

	Male
	Female

24.	What is your education? Please list your highest degree and major if applicable.

	(Select all that apply.)
	High School diploma
	Some college
	Associates Degree
	Bachelors Degree
	Some grad school
	Masters Degree
	Doctorate
	Major:

25.	How many years of experience do you have working with youth?

	1-5 years
	6-10 years
	11-15 years
	16-20 years
	20-30 years
	31+ years

26.	In what capacity?

	(Select all that apply.)
	Advocacy
	Counseling
	Mentoring
	Coaching
	High school staff
	Social worker
	Social Services
	Domestic Violence
	Childcare
	Parenting
	Recreation / After school programs
	Elementary School staff
	Middle School Staff
	Church
	Volunteer
	Other:

27.	What setting are you located in?

	Urban, low income
	Urban
	Suburban, low income
	Suburban
	Rural, low income
	Rural

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