Form SV-2010-0025 Youth Ambassadors Program (YAP) Colombian Pre-Program Su

Youth Ambassadors Program [Insert Year]: [Insert Country] Students

Pre-Program Survey

	Please know that your answers will be strictly confidential and will in no way affect your participation in the program. We will use the data for analytical and evaluative purposes only. Please feel free to give us your honest opinions. This survey is not a test, and there are no right or wrong answers. Thank you for your participation in this survey. Privacy Act and Paperwork Reduction Act Statements: The information solicited on this survey is requested pursuant to the Government Performance and Results Act of 1993 (P.L. 103-62) and the Mutual Educational and Cultural Exchange Act of 1961, as amended, also known as the Fulbright-Hays Act (22 U.S.C. 2451, et seq.). In order to ensure that the U.S. Department of State’s international exchange programs meet statutory program requirements (22 U.S.C. 2460(c)), the Department’s Bureau of Educational and Cultural Affairs (ECA) regularly monitors the programs, gathers data about program accomplishments, and evaluates selected ones. ECA uses the information collected to inform program design, management, and funding. All personal information that is collected through surveys is considered confidential. All responses are coded to ensure the confidentiality of individual responses. Data collected under this study will not be shared, sold, or used for fundraising purposes. Survey data and findings will be used only in an aggregate form for the express purposes of fulfilling the data needs of the outcome assessment. Responses to this survey are voluntary. Public reporting burden for this collection of information is estimated to average fifteen (15) minutes to respond to this survey, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An Agency may not conduct or sponsor, and respondents are not required to respond to, a collection of information unless it displays a valid OMB control number. Please send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to: A/ISS/DIR, U.S. Department of State, Washington, D.C. 20520.

SV-2010-0025

OMB No.: 1405-0158

Expiration Date: 04/30/2011

Estimated Burden Time: 15 minute

1. There are many different reasons for participating in the Youth Ambassador Program. In the table below, please identify your three most important reasons for participating.

To gain experience and knowledge about leadership
To prepare myself for a future leadership position in my country
To learn about community development (how to improve my neighborhood and community)
To increase my understanding of United States society, American people, and American culture
To increase my understanding of United States history
To learn more about United States Government and the American political system
To make friends with United States students and their families
To make friends with other participants from my country
To share my culture with others
To represent my country abroad
Other (please write in): _________________________________________

2. Please rate yourself on the following abilities. Please check one box in each row.

	Poor	Fair	Good	Excellent
Being self-reliant and being independent
Speaking in public
Listening to other people's suggestions or concerns
Expressing ideas and feelings
Being tolerant of others different than you
Leading a team and motivating others
Being flexible
Solving problems
Planning for the future
Managing your time
Managing money
Discussing your beliefs/values
Willing to make changes in your community

3. How much do you agree/disagree with the following statements as they relate to you as an individual? Please check one box in each row.

	Strongly Disagree	Somewhat Disagree	Neither Agree Nor Disagree	Somewhat Agree	Strongly Agree
I feel I have many choices in my life
I feel I can make a difference in my family
I feel I can make a difference in my community
I feel I can influence people around me

4. Please rate your current knowledge and understanding of the following topics highlighted in your program. Please check one box in each row.

	No Knowledge	Less Than Basic	Basic Knowledge	Beyond Basic	Advanced Knowledge
Leadership
Community service (helping others in my neighborhood, community or local organization)
Community development (how to improve my neighborhood and community)
Current issues facing United States society
Rights and responsibilities of a citizen
The diversity of the American people

	5. What do you see yourself as accomplishing or learning during this visit that you could not accomplish or learn at home? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

6. Please rate your knowledge or understanding of the following topics. Please check one box in each row.

	No Knowledge	Less Than Basic	Basic Knowledge	Beyond Basic	Advanced Knowledge
United States democracy
United States economy
United States values and culture
Religious and ethnic diversity in the United States
Freedom of speech and press in the United States
Voluntary community service in the United States
Daily Life in the United States

7. To what extent do you agree or disagree with the statements below? Please check one box in each row.

	Strongly Disagree	Disagree	Neither Agree Nor Disagree	Agree	Strongly Agree
Voting is important because real decisions are made in elections
Free and fair elections are the cornerstone of democracy
An independent media is important to the free flow of information
All citizens in a country should have equal rights and protections under the law, regardless of circumstances
The Rule of Law is fundamental to a functioning democracy
Individuals and organizations have the right to free speech and to voice opposition
Democratic principles enhance the workplace. Supervisors should incorporate democratic principles into their management practices

8. How do you view the United States government and the American people? Please check one box in each row.

	Strongly Unfavorable	Generally Unfavorable	Neither Favorable Nor Unfavorable	Generally Favorable	Strongly Favorable
United States Government
American people

9. How do you view the United States Government and its relationship with your home country?

	Strongly Disagree	Disagree	Neither Agree Nor Disagree	Agree	Strongly Agree
The United States government is a trustworthy partner for my country

10. Which of these fields are you considering studying or working in when you graduate from high school? Please check one box.

Agriculture
Arts and Humanities (history, languages, literature, art, theater, etc.)
Athletics
Business Administration, Finance
Computer Science, Information Technology
Education
Engineering
Environment
Government
Humanitarian Affairs, Development Assistance, Conflict Resolution
International Relations
Labor, Trade Unions
Law, Judicial, Law Enforcement
Library and Information Science
Media, Mass Communications, Journalism, Communication Technology, Advertising, Graphics
Medicine
Military Service
Public Administration
Public Health
Religion
Science (physics, math, chemistry, biology, astronomy, geography, agronomy)
Social Sciences (sociology, economics, psychology, political science)
Social Work
Teaching English, English language instructions
Teaching (General)
Not Sure
Other(please write in): _________________________________________

11. Which best describes the geographic location where you live? Please check one box.

A small city, town, or rural location in my country
Another major city in my country other than the capital
My country's capital city

	12. Age: [Drop-down]

13. Gender:

Female
Male

	14. Thank you for completing this survey! If you have additional comments you would like to make, about any of the things above, or something we haven’t touched upon, please do so here. ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

	15. How long did it take you to complete this survey?  ________ Minutes