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<p align="center"><img src="images/logo%20new.gif" width="374" height="71" alt="logo new.gif (5218 bytes)"></p>
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<p>Thank you in advance for filling out this survey. As a part of my Masters work at
The George Washington University, I took a class in Training Needs Assessment.
This course had several projects that were designed to enhance my knowledge and skill at
moving Training Needs Assessment from an Ad Hoc perspective to a Methodical one.</p>
<p>This is an on-line survey form, and when you click on submit comments below you will
automatically send me an e-mail that I will be able to evaluate on a spreadsheet.</p>
<p>As you are aware I am in the process of developing a Promotional Process Assessment
Center Training Program. This program is designed to include nine modules taken over
a nine week time period. (<a href="http://www.21stcenturyleaders.com/assessment_center_training_progr.htm">Click here
for further information on this exciting new <em><strong>21stcentruy leadership</strong></em>
product</a>) The program is a mixture of practical exercises heavily weighted with
self assessment and is based on the essential 'dimensions' evaluated in a typical
assessment center process.</p>
<p>By filling out and sending me the form below you will allow me to custom tailor the web
design to enhance this program to maximize the results for the fire fighters taking the
training.</p>
<p>Thanks,<br>
<img alt="BRUCES SIgnature.gif (6782 bytes)" src="images/BRUCES_SIgnature.gif" width="185" height="62"></p>
<form method="POST" action="_vti_bin/shtml.dll/ac%20feedback%20form.htm" webbot-action="--WEBBOT-SELF--">
<!--webbot bot="SaveResults" U-File="../_private/feedback.txt" S-Format="TEXT/TSV" S-Label-Fields="TRUE" B-Reverse-Chronology="FALSE" S-Email-Format="TEXT/PRE" S-Email-Address="tna [email protected]" B-Email-Label-Fields="TRUE" S-Builtin-Fields="Date Time REMOTE_NAME REMOTE_USER HTTP_USER_AGENT" startspan --><strong>[FrontPage Save Results Component]</strong><!--webbot bot="SaveResults" endspan i-checksum="6561" --><div align="center"><center><p><strong><big><big><big>FEEDBACK
FORM<br>
</big></big></big></strong>(Note: Please select one item from each drop down box.)</p>
</center></div><hr align="center">
<div align="center"><center><p><font color="#ff0000"><strong>Departmental Information</strong></font></p>
</center></div><p>What kind of Department are you in? <select name="D5" size="1">
<option value="Career ">Career</option>
<option value="Volunteer">Volunteer</option>
<option value="Combination ">Combination</option>
</select></p>
<p>Size in number of Members? <select name="D1" size="1">
<option value="1-50">1-50</option>
<option value="51-100">51-100</option>
<option value="101-200">101-200</option>
<option value="200-500">200-500</option>
<option value="500-1000">500-1000</option>
<option value="greater than 1000">greater than 1000</option>
</select></p>
<p>Does your department use an Assessment Center for its Promotional Process? <select name="D6" size="1">
<option value="yes">Yes</option>
<option value="No">No</option>
</select></p>
<p>If your department uses an Assessment Center, what kind of training is done prior to
the fire fighters taking the promotional process? <select name="D4" size="1">
<option value="None">None</option>
<option value="Orientation Only">Orientation Only (1-4 hours)</option>
<option value="One Day Orientation and Overview">One Day Orientation and Overview</option>
<option value="Two day to a Week Training">Two day to a Week Training</option>
<option value="Promotion Academy (Longer than a week)">Promotion Academy (Longer than a week)</option>
<option value="N/A">N/A No Assessment Center</option>
</select><dl>
<dt>Do you have computers in the stations accessible to the fire fighters? <select name="D7" size="1">
<option value="Yes">Yes</option>
<option value="No">No</option>
</select> </dt>
</dl>
<p>Do the stations have access to the internet? <select name="D8" size="1">
<option value="Yes">Yes</option>
<option value="No">No</option>
</select></p>
<p>If yes to the previous question, what is the communications speed of your Internet
Access? <select name="D2" size="1">
<option value="28000">28000 bps</option>
<option value="36000">36000 bps</option>
<option value="56000">56000 bps</option>
<option value="ISDN">ISDN</option>
<option value="T1/Fiber or higher">T1/Fiber or higher</option>
</select></p>
<p>Type of Browser used? <select name="D3" size="1">
<option value="Internet Explorer 4.0">Internet Explorer 4.0</option>
<option value="Internet Explorer (other)">Internet Explorer (other)</option>
<option value="Netscape Communicator">Netscape Communicator</option>
<option value="Netscape (other)">Netscape (other)</option>
<option value="Other Browser">Other Browser</option>
</select></p>
<p>Estimate what percentage of your members have acccess to home computers. <select name="D9" size="1">
<option value="100%">100%</option>
<option value="90%">90%</option>
<option value="80%">80%</option>
<option value="70%">70%</option>
<option value="60%">60%</option>
<option value="50%">50%</option>
<option value="40%">40%</option>
<option value="30%">30%</option>
<option value="20%">20%</option>
<option value="10%">10%</option>
<option value="0 %">0 %</option>
</select> </p>
<div align="center"><center><p><strong><font color="#ff0000">Respondent Computer
Information</font></strong></p>
</center></div><p>Do your personally have Internet Access at home? <select name="D10" size="1">
<option value="Yes">Yes</option>
<option value="No">No</option>
</select></p>
<p>What speed is your home internet connection? <select name="D11" size="1">
<option value="28000">28000 bps</option>
<option value="36000">36000 bps</option>
<option value="56000">56000 bps</option>
<option value="ISDN">ISDN</option>
<option value="T1/Fiber or higher">T1/Fiber or higher</option>
</select></p>
<p>What browser do you use? <select name="D12" size="1">
<option value="Internet Explorer 4.0">Internet Explorer 4.0</option>
<option value="Internet Explorer (other)">Internet Explorer (other)</option>
<option value="Netscape Communicator">Netscape Communicator</option>
<option value="Netscape (other)">Netscape (other)</option>
<option value="Other Browser">Other Browser</option>
</select></p>
<hr align="center">
<p><strong>Enter your other comments about this form and your promotional training process
in the space provided below:</strong><dl>
<dd><textarea cols="87" name="Comments" rows="5"></textarea> </dd>
</dl>
<p><strong>Tell us how to get in touch with you (<font color="#ff0000">optional</font> <font color="#FF0000">- mandatory if you want to be on our mailing list</font>):</strong><dl>
<dd><pre>Name <input maxLength="256" name="Username" size="35">
E-mail <input maxLength="256" name="UserEmail" size="35">
Tel <input maxLength="256" name="UserTel" size="35">
FAX <input maxLength="256" name="UserFAX" size="35"> </pre>
</dd>
</dl>
<dl>
<dd><input name="ContactRequested" type="checkbox" value="ContactRequested"> Please contact
me as soon as possible regarding this training program. </dd>
</dl>
<p><input type="submit" value="Submit Comments"> <input type="reset" value="Clear Form"></p>
</form>
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<h5 align="center">Copyright � 1998, 1999 <font color="#808000"><em><strong>21st century
leadership</strong></em></font>. All rights reserved.<br>
Revised: <!--webbot bot="TimeStamp" S-Type="EDITED" S-Format="%B %d, %Y" startspan -->May 29, 2001<!--webbot bot="TimeStamp" endspan i-checksum="11277" -->.</h5>
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