**CSAT Baseline Meeting Satisfaction Survey**

Form Approved

OMB NO. 0930-0197

Exp. Date 12/31/2004

See burden statement on the reverse side

**CENTER FOR SUBSTANCE ABUSE TREATMENT**

**Customer Survey---CSAT Meeting**

**Please enter the Personal ID code you used on the consent form here
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.**

**Date of training, location (i.e., city, state), and topic will be
pre-coded and entered in this area of the form.**

Very Very

[Satisfied]{.underline} [Satisfied]{.underline} [Neutral]{.underline}
[Dissatisfied]{.underline} [Dissatisfied]{.underline}

1\. How satisfied are you with the overall quality of\
this meeting? 1 2 3 4 5

2\. How satisfied are you with the quality of the

information/instruction from this meeting? 1 2 3 4 5

3\. How satisfied are you with the quality of the

meeting materials? 1 2 3 4 5

4\. Overall, how satisfied are you with your meeting\
experience? 1 2 3 4 5

PLEASE INDICATE YOUR AGREEMENT WITH Strongly Strongly THESE STATEMENTS
ABOUT THE TRAINING. [Agree]{.underline} [Agree]{.underline}
[Neutral]{.underline} [Disagree]{.underline} [Disagree]{.underline}

5\. The meeting class was well organized. 1 2 3 4 5

6\. The material presented in this meeting class will be

useful to me in dealing with substance abuse. 1 2 3 4 5

7\. I expect to use the information gained from this

meeting. 1 2 3 4 5

8\. I expect this meeting to benefit my clients. 1 2 3 4 5

9\. This meeting was relevant to substance abuse\
treatment. 1 2 3 4 5

10\. I would recommend this meeting to a colleague. 1 2 3 4 5

Very Not

[Useful]{.underline} [Useful]{.underline} [Neutral]{.underline}
[Useless]{.underline} [Applicable]{.underline}

11\. How useful was the information you received? 1 2 3 4 5

12\. Please indicate which title best describes your job:

\_\_Medical Director \_\_Clinical Administrator/Manager \_\_Federal
Government Official

\_\_Physician \_\_Clinical Supervisor \_\_State Government Official

\_\_Nurse \_\_Psychologist \_\_County Government Official

\_\_Physician's Assistant \_\_Counselor \_\_Researcher

\_\_Pharmacist \_\_Social Worker \_\_Other (please
specify)\_\_\_\_\_\_\_\_\_

\_\_Manager Director

13\. Please indicate which best describes your agency or affiliation:

\_\_Federal Government \_\_Substance Abuse Treatment Program

\_\_State Government \_\_University or other Higher education
institution

\_\_County Government \_\_Other (please describe)\_\_\_\_\_\_\_\_\_

\_\_Local Government

14\. What is your gender? 1.\_\_\_\_\_Male 2.\_\_\_\_\_Female

15\. Are you Hispanic or Latino? 1.\_\_\_\_\_Yes 2.\_\_\_\_\_No

16\. What is your race (Mark all that apply)?

\_\_Black or African American \_\_Alaska Native

\_\_Asian \_\_American Indian

\_\_White \_\_Native Hawaiian or Other Pacific Islander

What about the meeting/training was most useful in supporting your work
responsibilities?

How can we improve our meetings/training?

**Thank you for completing our survey.**

*Return your survey to the Survey Administrator for your Session.*

Public reporting burden for this collection of information is estimated
to average 10 minutes per response to complete the Contact Information
Form and this questionnaire. Send comments regarding this burden
estimate or any other aspect of this collection of information to the
SAMHSA Reports Clearance Officer, Room 16-105, 5600 Fishers Lane,
Rockville, MD 20857. An agency may not conduct or sponsor and a person
is not required to respond to a collection of information unless it
displays a currently valid OMB control number. The control number for
this project is 0930-0197.

**CSAT Follow-up Meeting Satisfaction Survey**

Form Approved

OMB NO. 0930-0197

Exp. Date 12/31/2004

See burden statement on the reverse side

CENTER FOR SUBSTANCE ABUSE TREATMENT

**Customer Survey---Meeting Follow-up**

**Personal ID Code, date of training, location (i.e., city, state), and
topic will be pre-coded and entered in this area of the form.**

**Please check here ( ) if you have received this survey in error,
(i.e., you did not attend the technical assistance listed above) and
return the uncompleted survey in the enclosed postage-paid envelope.**

PLEASE BASE YOUR ANSWER ON HOW YOU Very Very

FEEL ABOUT THE SESSION NOW. . [Satisfied]{.underline}
[Satisfied]{.underline} [Neutral]{.underline} [Dissatisfied]{.underline}
[Dissatisfied]{.underline}

1\. How satisfied are you with the overall quality of 1 2 3 4 5

the meeting?

2\. How satisfied are you with the quality of the\
information/instruction? 1 2 3 4 5

3\. How satisfied are you with the quality of the meeting\
materials? 1 2 3 4 5

4\. How satisfied are you that the meeting was relevant to\
substance abuse treatment? 1 2 3 4 5

5\. Overall, how satisfied are you with your meeting\
experience? 1 2 3 4 5

PLEASE INDICATE YOUR AGREEMENT WITH Strongly Strongly THESE STATEMENTS
ABOUT THE TRAINING. [Agree]{.underline} [Agree]{.underline}
[Neutral]{.underline} [Disagree]{.underline} [Disagree]{.underline}

6\. The material presented in the meeting has been

useful to me in consensus building. 1 2 3 4 5

7\. The meeting enhanced my skills in this topic area. 1 2 3 4 5

8\. The meeting was relevant to my career. 1 2 3 4 5

9\. The meeting has enabled me to serve my clients better. 1 2 3 4 5

10\. This meeting was relevant to substance abuse

treatment. 1 2 3 4 5

11\. I would recommend the meeting to a colleague. 1 2 3 4 5

12\. I would take additional meeting from CSAT. 1 2 3 4 5

Very Not

[Useful]{.underline} [Useful]{.underline} [Neutral]{.underline}
[Useless]{.underline} [Applicable]{.underline}

13\. How useful was the information you received

during the meeting/training? 1 2 3 4 5

[Yes]{.underline} [No]{.underline}

14\. Did you share any of the information from the meeting with others?
1 2

15\. Did you share any materials from the meeting with others? 1 2

16\. Have you applied any of what you learned in the meeting to your
work? 1 2

What about the meeting was most useful in supporting your work
responsibilities?

How can we improve our meetings?

**Thank you for completing our survey.**

*Return your survey in the enclosed reply envelope.*

Public reporting burden for this collection of information is estimated
to average 10 minutes per response to complete this questionnaire. Send
comments regarding this burden estimate or any other aspect of this
collection of information to the SAMHSA Reports Clearance Officer, Room
16-105, 5600 Fishers Lane, Rockville, MD 20857. An agency may not
conduct or sponsor and a person is not required to respond to a
collection of information unless it displays a currently valid OMB
control number. The control number for this project is 0930-0197.