California State University, Chico

School of Social Work

Distance Education Program

Employee Interest Survey

Demographic Information (this is data that will be used in an aggregate form to identify sub groups of the workforce who have an interest in this program)

Gender:

rMale

rFemale

rOther ______

Ethnicity:

rLatino

rAfrican American

rCaucasian

rAsian

rFirst Nation

Tribal Affiliation:______

rMulti racial

rOther ______

Age:

rUnder 30

r31 to 40

r41 to 50

r51 to 60

rOver 60

  1. Where do you live?

County ______City/Town______Rancheria ______

  1. Where do you currently work/volunteer?

rCounty mental health

rCommunity based/contracted agency

rTribal services

Other ______

  1. What is your job/volunteer title? ______
  1. What is your job classification? ______
  1. Are you interested in promoting to a higher job classification?

Yesr Nor

If yes, what would facilitate that promotion? (Check all that apply)

rAdditional training (short term training offered by employer)

rAdditional education (degree or certificate programs such as AA

degree, BSW, MSW, LVN, or RN)

rOther______

  1. What have been the barriers to gaining that promotion? (Check all that apply)

rTraining not available at a convenient time

rEducation not available at a convenient time

rEducation not available at a convenient place

rFinances

rJob positions at higher level not available

rOther______

  1. If training and education is a barrier to promotions, what keeps you from going to school or accessing training? (Check all that apply)

rThe commute

rFinances/cost of attending

rGetting release time from work

rLength of time it takes to complete the degree

rLimited time available due to work

rProgram not available

rFamily responsibilities

rLack of personal support (i.e. people make fun/stigmatize/segregate me/1st time college student) ______

rOther ______

  1. What is your immediate educational goal?

rHigh school/GED

rAA degree in Human Services

rBachelor's degree in Social Work (BSW)

rMaster's degree in Social Work (MSW)

rLicensed Vocation Nurse (LVN)

rRegistered Nurse (RN)

rBachelors of Nursing (BSN)

rMasters in Public Health (MPH)

rNurse Practitioners License (NP)

rOther degree______

  1. Would you be interested in enrolling in an AA, BSW or MSW degree in social work or nursing degree that was delivered via a mixture of online and face to face instruction? (check one)

rVery interested

rModerately interested but need more information

rNot interested

rAfter obtaining a high school diploma/GED

  1. Which type of program would make it possible for you to enroll in an AA, social work or nursing program?

rOn-line courses on the internet

rOn-site courses taught where I live

rVideo

rAll of the above

rOther______

Comments:

  1. What day/time arrangement would best suit your needs if courses were taught on site or through video?

rEvening

rWeek day

rWeekend

rAny of these

rOther______

Comments:

  1. How many courses do you think you would take in a semester?

rOne

rTwo

rThree

rFour (full time)

  1. If you were given time off work or flexible hours and financial support to participate in a degree program, are you willing to commit to ongoing employment in mental health/tribal services for an agreed upon period of time as the payback for your employers support during your education?

rYes

rNot sure

rProbably not

  1. Which of the following sites would you be able to travel to in order to take courses?

rLocal community college

rButte Community College

rShasta Community College

rLassen Community College

rCollege of the Redwoods

rCollege of the Siskiyou

rSierra College

rCounty agency/site – Name of site: ______

rCommunity site, Please specify ______

rOther, Please specify ______

  1. Is there anything else that you think we should know that would help you to enroll and complete a degree program that prepares you to work or advance in mental health/tribal services?

Comments: