EVALUATION INSTRUMENT TEMPLATE
MS Publisher documents will be available soon.
Simple Surveys
These tools are designed to utilize Likert-style questions. Using the resources provided, including the Training Resources below, you can write your own questions, insert them into the template, and tabulate results.
Standard Likert Questionnaire*
- Standard Questionnaire Template – MS Word
- Data Tabulation Spreadsheet – MS Excel
- Instructions for Data Tabulation Spreadsheet – MS Word
- *This could be used as a pre or posttest only or as a pre and posttest. If you do administer as pre and posttest, you would use the Retrospective Post-Then-Pre Data Tabulation Spreadsheet.
Retrospective Post-Then-Pre Questionnaire
- Standard Retro Questionnaire Template, Version 1 – MS Word
- Standard Retro Questionnair Template, Version 2 – MS Word
- Data Tabulation Spreadsheet – MS Excel
- Instructions for Data Tabulation Spreadsheet – MS Word
Other
- Audience Poll Template – MS Word
Combination Likert and Knowledge Questionnaires
The following surveys are designed to be youth-friendly. They resemble quizzes and include a variety of questions: knowledge (matching, multiple choice), intended behavior, perception, open-ended, etc. They also include space for Likert-style questions in a youth-friendly format for both the traditional Likert format as well as the Retrospective Post-Then-Pre format. Data Tabulation Spreadsheets are currently under development. We will provide guidance on how to modify the spreadsheets as needed.
Standard Survey*
- Combined Likert and Knowledge Survey Template – MS Publisher
- Combined Likert and Survey Example– PDF
- Data Tabulation Spreadsheet – Please contact Jennifer Cantwell for assistance
Retrospective Post-Then-Pre
- Combined Likert and Knowledge Survey Template – MS Publisher
- Combined Likert and Knowledge Survey Example – PDF
- Data Tabulation Spreadsheet – Please contact Jennifer Cantwell for assistance.
Impact Report Templates
These tools were designed to help you transfer your data into a reader-friendly, attractive document. These are meant to be a starting point and are easily adapted to meet your needs. We are hoping to develop templates for Club Meetings, Project Achievement, and Camp. These will have some generic program information included.
- Impact Report Template A – MS Publisher
- Impact Report Template B – MS Publisher
- Examples of Local Impact Reports
- Coastal Georgia 4-H Military Adventure Camp – MS PowerPoint
- Fort Stewart Science Day – MS PowerPoint
- Impact Statement Examples – PDF
Educational Club Meetings
The following surveys resemble quizzes and are currently being administered as posttest only. Most have a variety of questions: knowledge, intended behavior, perception, open-ended, etc. When utilized as posttest only, they measure “demonstration of knowledge” vs. “increase in knowledge.” They can be used as pre and posttests if desired. In the future we will provide more guidance on how to utilize them and calculate results as pre and posttest. Currently, the Data Tabulation Spreadsheets provide impact statements focused on posttest only results.
College Career Ready Performance Index (CCRPI): Career Awareness – Elementary School
These surveys are designed to align with the corresponding curricula developed by Georgia 4-H. The curricula can be found on the Staff Only section of the Georgia 4-H website: Additional Resources, Curriculum Resources, In-School Club Meeting. If you are not Georgia 4-H staff, please contact Mandy Marable. These surveys have Answer Keys and Data Tabulation Spreadsheets with pre-crafted impact statements. Directions for using the Data Tabulation Spreadsheets are included in a tab within each spreadsheet.
- Finance Survey – MS Publisher
- Finance Survey – PDF
- Finance Survey Answer Key – MS Publisher
- Finance Survey Answer Key – PDF
- Finance Data Tabulation Spreadsheet – MS Excel
- Government & Public Administration Survey – MS Publisher
- Government & Public Administration Survey – PDF
- Government & Public Administration Survey Answer Key – MS Publisher
- Government & Public Administration Survey Answer Key – PDF
- Government & Public Administration Data Tabulation Spreadsheet – MS Excel
- Information Technology Survey – MS Publisher
- Information Technology Survey – PDF
- Information Technology Survey Answer Key – MS Publisher
- Information Technology Survey Answer Key – PDF
- Information Technology Data Tabulation Spreadsheet – MS Excel
- Marketing Survey – MS Publisher
- Marketing Survey – PDF
- Marketing Survey Answer Key – MS Publisher
- Marketing Survey Answer Key – PDF
- Marketing Data Tabulation Spreadsheet – MS Excel
College Career Ready Performance Index (CCRPI): Career Exploration – Middle School
These surveys are designed to align with the corresponding curricula developed by Georgia 4-H. The curricula can be found on the Staff Only section of the Georgia 4-H website: Additional Resources, Curriculum Resources, In-School Club Meeting, Career Exploration. If you are not Georgia 4-H staff, please contact Laurie Murrah Hanson. Survey Answer Keys and Data Tabulation Spreadsheets with pre-crafted impact statements are currently under development.
- Survey Lesson 1 – Personalities – MS Publisher
- Survey Lesson 1 – Personalities – PDF
- Survey Answer Key – Lesson 1 – MS Publisher
- Survey Answer Key – Lesson 1 – PDF
- Data Tabulation Spreadsheet – Lesson 1 – MS Excel
- Survey Lesson 2 – Skill Inventory and Vocational Personality – MS Publisher
- Survey Lesson 2 – Skill Inventory and Vocational Personality – PDF
- Survey Answer Key – Lesson 2 – MS Publisher
- Survey Answer Key – Lesson 2 – PDF
- Data Tabulation Spreadsheet – Lesson 2 – MS Excel
- Survey Lesson 3 – Career Cluster Exploration – MS Publisher
- Survey Lesson 3 – Career Cluster Exploration – PDF
- Survey Answer Key – Lesson 3 – MS Publisher
- Survey Answer Key – Lesson 3 – PDF
- Data Tabulation Spreadsheet – Lesson 3 – MS Excel
- Survey Lesson 4 – Career Exploration – MS Publisher
- Survey Lesson 4 – Career Exploration – PDF
- Survey Answer Key – Lesson 4 – MS Publisher
- Survey Answer Key – Lesson 4 – PDF
- Data Tabulation Spreadsheet – Lesson 4 – MS Excel
- Survey Lesson 5 – Goals – MS Publisher
- Survey Lesson 5 – Goals – PDF
- Survey Answer Key – Lesson 5 – MS Publisher
- Survey Answer Key – Lesson 5 – PDF
- Data Tabulation Spreadsheet – Lesson 5 – MS Excel
- Survey Lesson 6 – Teamwork – MS Publisher
- Survey Lesson 6 – Teamwork – PDF
- Survey Answer Key – Lesson 6 – MS Publisher
- Survey Answer Key – Lesson 6 – PDF
- Data Tabulation Spreadsheet – Lesson 6 – MS Excel
- Survey General – Covers all 6 Lessons – MS Publisher
- Survey General – Covers all 6 Lessons – PDF
- Survey Answer Key – General Survey – MS Publisher
- Survey Answer Key – General Survey – PDF
- Data Tabulation Spreadsheet – General Survey – MS Excel
Other Educational Club Meetings
The following surveys were designed with county input based on curricula delivered in the classroom. Not all of he following surveys have a Data Tabulation Spreadsheets. Please check back in the future or contact Jennifer Cantwell if you have an urgent need for the Data Tabulation Spreadsheet.
- Bullying Survey – MS Publisher
- Bullying Survey – PDF
- Bullying Survey Answer Key – MS Publisher
- Bullying Survey Answer Key – PDF
- Bullying Data Tabulation Spreadsheet – MS Excel
- Manners Worth Millions Survey – MS Publisher
- Manners Worth Millions Survey – PDF
- Manners Worth Millions Survey Answer Key – MS Publisher
- Manners Worth Millions Survey Answer Key – PDF
- Manners Worth Millions Data Tabulation Spreadsheet – MS Excel
- States of Matter: Physical vs. Chemical Changes Survey – MS Publisher
- States of Matter: Physical vs. Chemical Changes Survey – PDF
- States of Matter: Physical vs. Chemical Changes Survey Answer Key – MS Publisher
- States of Matter: Physical vs. Chemical Changes Survey Answer Key – PDF
- States of Matter Data Tabulation Spreadsheet – MS Excel
Health Rocks – Less Stress on the Test
This survey is designed to align with the Health Rocks! Less Stress On The Test curricula and corresponding Friends book. The curricula can be found on the Staff Only section of the GA 4-H website. If you are not Georgia 4-H staff, please contact Mandy Marable.
- Less Stress on the Test Survey – MS Publisher
- Less Stress on the Test Survey – PDF
- Less Stress on the Test Survey Answer Key – MS Publisher
- Less Stress on the Test Survey Answer Key – PDF
- Less Stress on the Test Data Tabulation Spreadsheet – MS Excel
Farm to Fork
This survey is designed to align with the Farm to Fork Friends book. The curriculum can be found on the Staff Only section of the Georgia 4-H website. If you are not Georgia 4-H staff, please contact Mandy Marable.
- Farm to Fork Survey – MS Publisher
- Farm to Fork Survey – PDF
- Farm to Fork Survey Answer Key – MS Publisher
- Farm to Fork Survey Answer Key – PDF
- Farm to Fork Data Tabulation Spreadsheet – MS Excel
Inherited Plant Traits
This survey is designed to align with the Georgia 4-H Agriscience Inherited Plant Traits lesson. The curriculum can be found on the Staff Only section of the Georgia 4-H website. If you are not Georgia 4-H staff, please contact Mandy Marable.
- Inherited Plant Traits Survey – MS Publisher
- Inherited Plant Traits Survey – PDF
- Inherited Plant Traits Survey Answer Key – MS Publisher
- Inherited Plant Traits Survey Answer Key – PDF
- Inherited Plant Traits Data Tabulation Spreadsheet – MS Excel
Inherited vs Acquired Traits
This survey is designed to align with the Georgia 4-H Agriscience Inherited Plant Traits lesson. The curriculum can be found on the Staff Only section of the Georgia 4-H website. If you are not Georgia 4-H staff, please contact Mandy Marable.
- Inherited vs Acquired Traits Survey – PDF
- Inherited vs Acquired Traits Survey Answer Key – PDF
- Inherited vs Acquired Traits Data Tabulation Spreadsheet – MS Excel
Microorganisms
- Microorganisms Survey – PDF
- Microorganisms Survey Answer Key – PDF
- Microorganisms Data Tabulation Spreadsheet – MS Excel
Georgia Barrier Islands
This survey is designed to align with the Georgia 4-H Agriscience Georgia Barrier Islands lesson(s). The curriculum can be found on the Staff Only section of the Georgia 4-H Website. If you are not Georgia 4-H staff, please contact Mandy Marable.
- Georgia Barrier Islands Survey – MS Publisher
- Georgia Barrier Islands Survey – PDF
- Georgia Barrier Islands Survey Answer Key – MS Publisher
- Georgia Barrier Islands Survey Answer Key – PDF
- Georgia Barrier Islands Data Tabulation Spreadsheet – MS Excel
- Clouds
- Georgia Crops
- Magnets & Electromagnets
- Energy Drinks
Project Achievement
This sections contains current Project Achievement Surveys to be used for the 2016-2017 program year. These surveys are designed to be administered to youth after participating in Project Achievement at District level.
- 4th – 6th Grade (Cloverleaf) Project Achievement
- 4th – 6th Grade Project Achievement Survey – MS Publisher
- 4th – 6th Grade Project Achievement Survey – PDF
- 4th – 6th Grade Project Achievement Survey Answer Key – MS Publisher
- 4th – 6th Grade Project Achievement Survey Answer Key – PDF
- 4th – 6th Grade Project Achievement Data Tabulation Spreadsheet – MS Excel
- 7th – 12th Grade (Junior/Senior) Project Achievement
- 7th – 12th Grade Project Achievement Survey – MS Publisher
- 7th – 12th Grade Project Achievement Survey – PDF
- 7th – 12th Grade Project Achievement Survey Answer Key – MS Publisher
- 7th – 12th Grade Project Achievement Survey Answer Key – PDF
- 7th – 12th Grade Project Achievement Data Tabulation Spreadsheet – MS Excel
END OF THE YEAR TEACHER SURVEY- 2020-2021 Program Year
- For assistance in using this survey, please contact Jennifer Cantwell at jecantw@uga.edu or 706-542-4294. This survey can be distributed as a paper copy or through Qualtrics. Even if you distribute the paper copy, you still need to enter the results in Qualtrics. Please see the EOY Teacher Survey How to Guides for more information about how to utilize the survey and how to obtain a CAES UGA Qualtrics account. Please see additional resources below.
- Zoom Recording of Instructional Session – How to edit and distribute the survey and pull results.
- EOY Teacher Survey Process
- Qualtrics 101
- EOY Teacher Survey Template –
TRAINING RESOURCES
- Simple Survey Resources PowerPoint Presentation – 2014 NAE4-HA Conference, Minneapolis, MN
- Simple Surveys PowerPoint Presentation – 2014 Southern Region Biennial Conference
- Simple Evaluation Templates PowerPoint Presentation – 2015 Camping & Environmental Education Institute
- Simple Survey Resources: Templates, Tabulation & Impact for Novices – PowerPoint Presentation – 2015 National Urban Extension Conference
- 4-H Simple Evaluation Templates Revamped: Gathering Data for Program Improvement and Impact Reporting – PowerPoint Presentation – 2015 NAE4-HA Conference, Portland, OR
- Simple Surveys: From Program Objectives to Impact Statements in 90 Minutes, PowerPoint Presentation – 2016 Georgia Cooperative Extension Winter Conference, Eatonton, GA
- Improving Impact Statements Using Survey Data, PowerPoint Presentation – 2016 Georgia Cooperative Extension Conference, Eatonton, GA
- Verbs for Writing Measurable Objectives – MS Word
INVITED PRESENTATIONS
- 2011 Youth Service America’s Youth Service Institute, Philadephia, PA
- 2012 University of Georgia, College of Agricultural & Environmental Sciences, Cooperative Extension Winter School, Eatonton, GA
- 2013 Southeastern 4-H Professional Improvement Conference, Eatonton, GA
- 2013 JCEP (Joint Council of Extension Professionals) GALAXY Conference, Pittsburg, PA
- 2014 Military Partnership Conference, Washington D.C.
- 2014 Southern Region Biennial 4-H Conference, Charleston, SC
- 2014 National Association of Extension & 4-H Agents Conference, Minneapolis, MN
- 2014 Volunteer Conference of Southern States, Eatonton, GA
- 2015 Camping & Environmental Education Institute, Eatonton, GA
- 2015 National Urban Extension Conference, Atlanta, GA
- 2015 National Association of Extension & 4-H Agents Conference, Portland, OR
- 2016 Georgia Cooperative Extension Conference, Eatonton, GA
- 2016 National Association of Extension & 4-H Agents Conference, New Orleans, LA
Contact
Jennifer Cantwell
328 Hoke Smith Annex
University of Georgia
Athens, GA 30602-4356
Phone:706-542-4294
Fax: 706-542-4373
jecantw@uga.edu
The University of Georgia College of Agricultural and Environmental Sciences (working cooperatively with Fort Valley State University, the U.S. Department of Agriculture, and the counties of Georgia) offers its educational programs, assistance, and materials to all people without regard to race, color, religion, sex, national origin, disability, gender identity, sexual orientation or protected veteran status and is an Equal Opportunity, Affirmative Action organization.