Public Awareness Testing Survey Form
Public Awareness Testing Survey Form to measure public understanding, awareness, and feedback for the topic being tested. Please answer honestly and use the same title consistently throughout the form.
Respondent Profile
Respondent role/type
*
Member of the public
Community advocate
Student
Educator
Public sector worker
Research participant
Other
Affiliation or organization name
Awareness Survey
Please rate the following statements
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I am familiar with this topic.
1
2
3
4
5
The information I have encountered is clear.
6
7
8
9
10
This topic feels relevant to me.
11
12
13
14
15
I feel confident discussing this topic.
16
17
18
19
20
Overall awareness level
*
1
2
3
4
5
Primary information source
*
Please Select
News media
Social media
Workplace or school
Friends or family
Community events
Official websites
Other
Other exposure channels
News media
Social media
Workplace or school
Friends or family
Community events
Official websites
Podcasts
Printed materials
Other
Open Feedback
Key takeaway or improvement suggestion
Additional feedback
Submission Details
Email for follow-up
example@example.com
May we contact you for clarification?
*
Yes
No
Submit
Should be Empty: