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Instrument 2: Survey for Trainer Feedback on Curriculum Following 

Usage with Case Managers

Respondents: Trainer Cohort Members

Collection Strategy: Paper Form

Thank you for completing this survey as part of our evaluation of trainings based on the FET 

Toolkit. Please note that your responses will be kept confidential, and when survey results are 

reported none of your answers will be connected to your organization.

Please enter your organization’s name: _________________________________

Contextual Information

1) How many case managers participated in this training? ____________

2) In what city and state was the training held? ___________________________

3) What was the total duration of this training (excluding breaks)? ____________________

4) Describe the backgrounds of the case managers that participated in this training and the range of 

the organizations for which they work.

__________________________________________________________________________________

__________________________________________________________________________________

5) Please check any of the following that describe the clients with whom the case managers you train

will be working (check all that apply).

Race/Ethnicity Geography Socio-economic

 Mostly White  Mostly Urban  Mostly Low-Income

 Mostly Non-White Minority  Mostly Suburban

 Mostly African-American  Mostly Rural Gender

 Mostly Hispanic/Latino  Mostly Female

 Mostly Male

6) Will the case managers you train usually be working with their clients face-to-face or by 

telephone?

 Face-to-face

 By telephone

 Both face-to-face and by telephone
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7) What types of services are clients generally seeking when they contact the case managers that 

you will be training? (For example, are they looking for assistance with housing? Assistance with 

health issues?, etc.)

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Feedback on Toolkit Modules

In the following section of the survey, we would like you to describe your experiences and satisfaction 

with each of the individual modules in the Financial Empowerment Toolkit. If you need additional space 

for any of your answers, please use the back of the page.
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Module

On a scale of 1 to 5, 

how useful do you 

think these 

resources will be to 

the participants?

How many 

minutes did 

you spend 

discussing

this module?

What content in this 

module will be most 

useful for 

participants?

What content or tools in 

this module will be less 

useful for participants, if 

any, and why?

What feedback do you 

have for how this module

should be revised?

Module 1: 

Introduction to 

the Toolkit

 5: Extremely useful

 4

 3

 2

 1: Not at all useful

___________

 I did not 

discuss this 

module during

this training

Module 2: 

Assessing the 

Situation

 5: Extremely useful

 4

 3

 2

 1: Not at all useful

___________

 I did not 

discuss this 

module during

this training
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Module

On a scale of 1 to 5, 

how useful do you 

think these 

resources will be to 

the participants?

How many 

minutes did 

you spend 

discussing

this module?

What content in this 

module will be most 

useful for 

participants?

What content or tools in 

this module will be less 

useful for participants, if 

any, and why?

What feedback do you 

have for how this module

should be revised?

Module 3: 

Starting the

Conversation

 5: Extremely useful

 4

 3

 2

 1: Not at all useful

___________

 I did not 

discuss this 

module during

this training

Module 4: 

Setting Goals

 5: Extremely useful

 4

 3

 2

 1: Not at all useful

___________

 I did not 

discuss this 

module during

this training
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Module

On a scale of 1 to 5, 

how useful do you 

think these 

resources will be to 

the participants?

How many 

minutes did 

you spend 

discussing

this module?

What content in this 

module will be most 

useful for 

participants?

What content or tools in 

this module will be less 

useful for participants, if 

any, and why?

What feedback do you 

have for how this module

should be revised?

Module 5: 

Saving for the 

Unexpected, 

Emergencies, 

and Goals

 5: Extremely useful

 4

 3

 2

 1: Not at all useful

___________

 I did not 

discuss this 

module during

this training

Module 6: 

Managing Cash 

Flow

 5: Extremely useful

 4

 3

 2

 1: Not at all useful

___________

 I did not 

discuss this 

module during

this training
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Module

On a scale of 1 to 5, 

how useful do you 

think these 

resources will be to 

the participants?

How many 

minutes did 

you spend 

discussing

this module?

What content in this 

module will be most 

useful for 

participants?

What content or tools in 

this module will be less 

useful for participants, if 

any, and why?

What feedback do you 

have for how this module

should be revised?

Module 7: 

Dealing with 

Debt

 5: Extremely useful

 4

 3

 2

 1: Not at all useful

___________

 I did not 

discuss this 

module during

this training

Module 8: 

Understanding 

Credit Reports 

and Scores

 5: Extremely useful

 4

 3

 2

 1: Not at all useful

___________

 I did not 

discuss this 

module during

this training
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Module

On a scale of 1 to 5, 

how useful do you 

think these 

resources will be to 

the participants?

How many 

minutes did 

you spend 

discussing

this module?

What content in this 

module will be most 

useful for 

participants?

What content or tools in 

this module will be less 

useful for participants, if 

any, and why?

What feedback do you 

have for how this module

should be revised?

Module 9: 

Evaluating 

Financial 

Service 

Providers, 

Products, and 

Services

 5: Extremely useful

 4

 3

 2

 1: Not at all useful

___________

 I did not 

discuss this 

module during

this training

Module 10: 

Protecting 

Consumer 

Rights

 5: Extremely useful

 4

 3

 2

 1: Not at all useful

___________

 I did not 

discuss this 

module during

this training
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Overall Reaction and Feedback

8) Is there anything that you did during this training that worked particularly well?

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

9) Is there anything that you would do differently if you were to do this training again?

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

10) Are there any topics that you believe should be covered in more detail in the Toolkit, or any 

additional tools or resources that should be added?

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

11) Thinking about the goal of equipping case managers to integrate financial empowerment into 

their work, please provide any other suggestions you have for how the Toolkit could be improved.

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Paperwork Reduction Act

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person 

is not required to respond to a collection of information unless it displays a valid OMB control number. 

The OMB control number for this collection is 3170-XXXX. It expires on MM/DD/YYYY. The time 

required to complete this information collection is estimated to average approximately 20 minutes per 
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response, including the time for reviewing any instructions, searching existing data sources, gathering 

and maintaining the data needed, and completing and reviewing the collection of information. The 

obligation to respond to this collection of information is voluntary. Comments regarding this collection 

of information, including the estimated response time, suggestions for improving the usefulness of the 

information, or suggestions for reducing the burden to respond to this collection should be submitted to 

Bureau at the Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G Street NW, 

Washington, DC 20552, or by email to CFPB_Public_PRA@cfpb.gov.

The Bureau will not disclose any personally identifiable information collected except to the extent that it 

is required to do so by law and as provided in the Privacy Act Statement listed below. Additionally, the 

Bureau will treat the information collected consistent with its confidentiality regulations at 12 C.F.R. Part 

1070, et seq.