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APPENDIXES
APPENDIX A
QUESTIONNAIRE
Ethiopia SEL Study Informed Consent Form
Dear Participant,
Thank you for your interest in this survey. Please answer every question to the best of your ability. There are no right or wrong answers. Your data will be treated confidentially, which means that your answers will be labelled with a number instead of your name so that even those reading your responses will not know who you are. Remember that at all times of this study, your participation is completely voluntary. You have the right to stop answering questions at any time. If you have any questions about the research study, please contact jennifer.jagerson@vanguard.edu or InstitutionalReviewBoard@vanguard.edu. This research has been carefully designed to protect you and was reviewed according to Vanguard University Institutional Review Board procedures for research involving human subjects.
PinkGirl Leader: Please sign here that you consent to participate: ____________________________
Current or former PinkGirl (“the participant”): Please sign here that you consent to participate: ____________________________
If participant is a minor: Legal representative’s consent for the minor to participate: _______________________________
Please go to the next page to start the survey. Thank you very much for your participation!
Sincerely,
Jennifer Jagerson, Ph.D.
jennifer.jagerson@vanguard.edu
Sibylle Georgianna, Ph.D.
sibylle.georgianna@vanguard.edu
Ethiopia Social and Emotional
Learning Study
Quantitative Survey Form
A Personal Infomation
Your Study Number:____________________________
What is your age? _______________________________
What is your gender? _______________________________
What is your marital status? ______________________________
How many children (under 18 years old) are living in your household?_____________________
How many children that are currently living in your household are 10 years old or younger? ______
Do you live with (check all that apply):
□ Mother?
□ Father?
□ Both father and mother?
□ Uncle/aunt?
□ Grandmother
□ Grandfather(s)
□ Sibling
□ Other: _______________________________
How much does the care of your sibling(s) depend on you?
Not at all 1 2 3 4 5 6 7 Very much
□ □ □ □ □ □ □
How much does the care of your sibling(s) depend on another person?
Not at all 1 2 3 4 5 6 7 Very much
□ □ □ □ □ □ □
Check the main person(s) who does/do the majority of care of your sibling(s):
□ Mother
□ Father
□ Both father and mother
□ Uncle
□ Aunt
□ Grandmother
□ Grandfather(s)
□ Other: _______________________________
How much does the care of your other family members (e.g., elderly, disabled) depend on you?
Not at all 1 2 3 4 5 6 7 Very much
□ □ □ □ □ □ □
How much does the care of your other family members depend on another person?
Not at all 1 2 3 4 5 6 7 Very much
□ □ □ □ □ □ □
Which of the following job describes your current job the best? You may check off more than one box.
(If you are in school and not working, please skip this question and go to the next question):
□ Accounting, banking or finance □ Environment and agriculture □ Psychology
□ Healthcare □ Recruitment and Human Resources
□ Business, consulting or management □ Hospitality
□ Information Technology □ Research/Science
□ NGO work □ Law □ Retail
□ Creative arts or design
□ Customer Service □ Law enforcement and security □ Sales
□ Leisure, sports, and tourism □ Social Work
□ Energy and utilities □ Marketing, advertising, and public relations □ Teaching and Education
□ Engineering and manufacturing □ Media and publishing □ Other: ___________________________
Which of the following describe best your career goals?
□ Accounting, banking or finance □ Engineering and manufacturing
□ Business, consulting or management □ Environment and agriculture
□ Non-profit or volunteer work □ Healthcare
□ Creative arts or design □ Hospitality
□ Customer Service □ Information Technology
□ Energy and utilities □ Law
□ Law enforcement and security □ Retail
□ Leisure, sports, and tourism □ Sales
□ Marketing, advertising, and public relations □ Social care
□ Media and publishing □ Teaching and Education
□ Recruitment and Human Resources □ Transport and logistics
□ Research/Science □ Other: _______________________________
What is your native language? _____________________________
What is your ethnicity? _______________________________
What is the highest level of education or training that you have successfully completed?
□ Passed the 8th grade exam
□ Passed the 10th grade exam
□ Passed the 12th grade exam
□ Two years technical diploma
□ Completed diploma for a vocational school
□ Bachelor’s Degree level
□ Master’s Degree level
□ Doctoral Degree
□ None
□ Other (please specify): _______________________________
What year are you in school?______________________________
What year did you start Pink Girl?_______________________________
If you have graduated, have you gone to college? ________
If you are in college, which year are you in college?________
If you have graduated from college, how long has it been since you graduated?_________
During Your Time in Pink Girl:
How many years in life skill classes did you complete?_________
From the twelve life skills classes per year, about how many in total have you taken?
(Examples: 5, 29, 36) ______________
How many years of Saturday tutoring did you complete? ________
How many home visits were done by the leadership team? ________
Which part of PinkGirl has been the most helpful to you? Please rank the following options in order of importance by numbering from 1-6 in the boxes provided (1 is most important).
□ Saturday classes □ Mentor (Life Skills Coach) relationship
□ English summer camp □ Cohort group
□ Life Skills classes □ Special exam prep classes
□ Other ____________
From the following list, which of the core living values are the most important to implement your life skills? Please put an “X” in the top five.
□ honesty □ gratitude □ responsibility
□ love □ unity □ encouragement
□ peace □ freedom □ integrity
□ cooperation □ perseverance □ respect
□ humility □ tolerance □ joy
During Your Time in Pink Girl:
Instruction: Please identify and then describe a relationship outside of your family that is most important to you. If there are several
relationships that are on your mind, choose the most important one.
Your most important relationship outside of your family (write here): ________________________________
1. How satisfied are you with the relationship?
Not at all 1 2 3 4 5 6 7 Very much
□ □ □ □ □ □ □
Instruction: Please identify and then describe a school or career related goal that is most important to you right now. If there are several school or career related goals that are on your mind, choose the most important one.
Your most important school/career goal (write here): _______________________________
1. How likely do you think it is that you will accomplish your goal
Not at all likely 1 2 3 4 5 6 7 Very likely
□ □ □ □ □ □ □
2. How important is it for you to accomplish your goal?
Not at all important 1 2 3 4 5 6 7 Very important
□ □ □ □ □ □ □
3. How much does the fulfilment of your goal depend on circumstances outside of your control?
Not at all 1 2 3 4 5 6 7 Very much
□ □ □ □ □ □ □
List three people who support you most in accomplishing your goal?
Examples: Mother, Father, mentor, teacher, Life Skills coach, grandfather, friend, etc.
__________________________ ________________________ ________________________
How satisfied are you with your life in general?
Not at all 1 2 3 4 5 6 7 Very much
□ □ □ □ □ □ □
1. Your Skills of Knowing Yourself,
Living with Yourself, and Living with Others
Living with Yourself, and Living with Others
Social-Emotional: Self Management/Decision-making Skills
First, we’d like to learn more about your behavior, experiences, and attitudes.
Please answer how often you did the following during the past 30 days. During the past 30 days…
1. I came to class prepared.
Almost never Once in a while Sometimes Often Almost all of the time
□ □ □ □ □
2. I remembered and followed directions.
Almost never Once in a while Sometimes Often Almost all of the time
□ □ □ □ □
3. I got my work done right away instead of waiting until the last minute.
Almost never Once in a while Sometimes Often Almost all of the time
□ □ □ □ □
4. I paid attention, even when there were distractions.
Almost never Once in a while Sometimes Often Almost all of the time
□ □ □ □ □
5. I worked independently with focus.
Almost never Once in a while Sometimes Often Almost all of the time
□ □ □ □ □
6. I stayed calm even when others bothered or critcized me.
Almost never Once in a while Sometimes Often Almost all of the time
□ □ □ □ □
7. I allowed others to speak without interruption.
Almost never Once in a while Sometimes Often Almost all of the time
□ □ □ □ □
8. I was polite to adults and peers.
Almost never Once in a while Sometimes Often Almost all of the time
□ □ □ □ □
9. I kept my temper in check.
Almost never Once in a while Sometimes Often Almost all of the time
□ □ □ □ □
Social-Emotional: Growth Mindset/Coping with Stress/Self understanding
In this section, please think about your learning in general.
Please indicate how true each of the following statements is for you:
Not at all True A Little True Somewhat True Mostly True Completely True
□ □ □ □ □
10. My intelligence is something that I can’t change very much.
Not at all True A Little True Somewhat True Mostly True Completely True
□ □ □ □ □
11. Challenging myself won’t make me any smarter.
Not at all True A Little True Somewhat True Mostly True Completely True
□ □ □ □ □
12. There are some things I am not capable of learning.
Not at all True A Little True Somewhat True Mostly True Completely True
□ □ □ □ □
13. If I am not naturally smart in a subject, I will never do well in it.
Not at all True A Little True Somewhat True Mostly True Completely True
□ □ □ □ □
Social-Emotional: Self-Efficacy (Global)/Self Esteem/Assertiveness
How confident are you about the following at school?
14. I can earn an A in my classes.
Not at all Confident A Little Confident Somewhat Confident Mostly Confident Completely Confident
□ □ □ □ □
15. I can do well on all my tests, even when they’re difficult.
Not at all Confident A Little Confident Somewhat Confident Mostly Confident Completely Confident
□ □ □ □ □
16. I can master the hardest topics in my classes.
Not at all Confident A Little Confident Somewhat Confident Mostly Confident Completely Confident
□ □ □ □ □
17. I can meet all the learning goals my teachers set.
Not at all Confident A Little Confident Somewhat Confident Mostly Confident Completely Confident
□ □ □ □ □
Social-Emotional: Social Awareness/Relating with
Others/Friendship formation and maintenance
In this section, please help us better understand your thoughts and actions when you are with other people. Please answer how often you did the following during the past 30 days. During the past 30 days…
18. How carefully did you listen to other people’s points of view?
Not Carefully At All Slightly Carefully Somewhat Carefully Quite Carefully Extremely Carefully
□ □ □ □ □
19. How much did you care about other people’s feelings?
Did Not Care At All Cared A Little Bit Cared Somewhat Cared Quite A Bit Cared A Tremendous Amount
□ □ □ □ □
20. How often did you compliment others’ accomplishments?
Almost never Once in a while Sometimes Often Almost all of the time
□ □ □ □ □
21. How well did you get along with students who are different from you?
Did Not Get Along At All Got Along A Little Bit Got Along Somewhat Got Along Pretty Well Got Along Extremely Well
□ □ □ □ □
22. How clearly were you able to describe your feelings?
Not At All Clearly Slightly Clearly Somewhat Clearly Quite Clearly Extremely Clearly
□ □ □ □ □
23. When others disagreed with you, how respectful were you of their views?
Not At All Respectful Slightly Respectful Somewhat Respectful Quite Respectful Extremely Respectful
□ □ □ □ □
24. To what extent were you able to stand up for yourself without putting others down?
Not At All A Little Bit Somewhat Quite A Bit A Tremendous Amount
□ □ □ □ □
25. To what extent were you able to disagree with others without starting an argument?
Not At All A Little Bit Somewhat Quite A Bit A Tremendous Amount
□ □ □ □ □
26. To what extent do you feel safe at school?
Not at all 1 2 3 4 5 6 7 Very much
□ □ □ □ □ □ □
27. Is there anything that makes you feel safer? (Examples: going to class with a friend, receiving tutoring) ______________________
Thank you very much for your participation!
APPENDIX B
Semi-structured Interview Guide
From: Diana Avans, PhD
Chair of Institutional Review Board, Address: 55 Fair Dr. Costa Mesa, CA 92626, USA; Email: davans@vanguard.edu
Date: April 7, 2019
To: Dr. Jennifer Jagerson
RE: “On supporting the marginalized: The efficacy of social and emotional learning and academic support for Ethiopian teenagers by Pink Girl”
Dear Dr. Jagerson,
The above referenced human-subjects research project has been approved by the Vanguard University Institutional Review Board. This approval is limited to the activities described in the approved Protocol Narrative. In accordance with this approval, the specific conditions for the conduct of this research are listed below, and informed consent from subjects must be obtained as indicated. All changes (e.g. a change in procedure, number of subjects, personnel, study locations, new recruitment materials, study instruments, etc.) to the approved protocol or consent form first be reviewed and approved by the IRB before they are implemented. Please email the IRB when you have completed your study.
Add a participant “assent” signature line (for those <18-years) on informed consent; record oral consent on interview.
Sincerely,
Diana Avans
Diana Avans, PhD
Chair, Institutional Review Board
APPENDIX C
Semi-structured Interview Guide
Ethiopia Qualitative Study June 2019
- How did you initially become involved with PinkGirl?
- What was your first experience like when you joined the organization?
- How has being a part of PinkGirl affected your life?
o What aspects of PinkGirl have been most helpful? (Examples, tutoring in general, particular tutors, the Life
Skills class, having a Life Skills mentor, having a cohort of your peers, other events put on by PinkGirl, etc.)
▪ Why do you think that or those aspects were helpful?
▪ What has been the impact of these factors on you?
o Are there any aspects of PinkGirl that have been unhelpful or detrimental?
▪ What was the impact of those aspects of PinkGirl?
• Most Significant Change Question: What do you believe is the most important thing that PinkGirl does to
help support your life?