designed by lukas boruta copyright 2008 ICEO Inc. 
 
 

12-month Work & Travel Pilot Program Final Evaluation

Participant Information
 
DS 2019 #:
Social Security #:
Last Name:
First Name:
Middle:
Country of Citizenship:
Date of Birth (month/day/year):

US Home Mailing Address
Address:
City:
State:
Zip Code:
Country:
Telephone:
Email:
Employment Information
(Please list all employment held while participating in ICEO’s 12-month Work and Travel Pilot Program, starting with the most recent.)
 
Employer Name:
Employer Address:
City:
State:
Zip Code:
Name of Supervisor:
Title:
Telephone:
Fax:
Email:
Employment start date (month/day/year):
Employment end date (month/day/year):
Starting employment position:
wage $ per hour:
Ending employment position:
wage $ per hour:
 
Employer Name :
Employer Address:
City:
State:
Zip Code:
Name of Supervisor:
Title:
Telephone:
Fax:
Email:
Employment start date (month/day/year):
Employment end date (month/day/year):
Starting employment position:
wage $ per hour:
Ending employment position:
wage $ per hour:
 
On average, how many hours per week did you work?
5-10 11-20 21-30 31-40 40+
On average, how much money did you earn per week (before deductions)?
Less than $50 $50-$150 $150-250 $250-$350 $350-$450
$450-$550 $550-$650 More than $650
What were your total earnings during the 12-month Work & Travel Pilot Program (before deductions)?
Less than $500 $500-$2000 $2000-$3500 $3500-$5000
$5000-$6500 $6500-$8000 $8000-$9500 More than $9500
How many months did you work during the program?
0-1 2-3 4-5 6-7 8-9 10-11 All 12 months
Additional Comments:
Housing
 
Did you follow your Post Arrival Guide to find housing?
yes no
If yes, was it useful in your search?
yes no
How many weeks did it take you to find permanent housing?
1-2 3-4 5-6 7-8 9-10 11-12 I stopped looking
Did you utilize ICEO’s Regional Rep. Assistance for housing?
yes no
If yes, how many weeks did it take to receive your housing?
1-2 3-4 5-6 7-8 9-10 11-12
How long did you stay in your temporary housing before moving to permanent housing (in weeks)?
1 2 3 4
I stayed in the temporary housing location for the entire program
What type of accommodations did you stay in during the program?
Employer housing Apartment Hotel/Motel
Hostel Other :
What was the cost of your accommodations per month (if you shared housing please just provide what your share of rent was)?

Less than $100 $100-$150 $150-200 $200-$250

$250-$300 $300-$350 $350-$400 More than $400

What was the distance from your accommodations to your employer?

Less than 5 minutes 5-10 minutes 10-15 minutes

15-20 20-25 More than 25 minutes

Additional Comments:
General Program Evaluation
 
Please rate the following questions on a scale of 1 - 4 ( 1 - poor, 2 - ok, 3 - good, 4 - great)
 
1. How would you rate ICEO’s 12-month Work/Travel Pilot Program as a whole?
1 2 3 4
Please provide any comments you may have:
2. How would you rate ICEO’s overseas recruiting partner? (if applicable)
1 2 3 4
3. How would you rate the Embassy process before you arrived to the US?
1 2 3 4
4. How would you rate your home country agency’s international air flight assistance? (if applicable)
1 2 3 4
5. How would you rate your international flight to the US?
1 2 3 4
6. How would you rate the Post Arrival Guide provided by ICEO?
1 2 3 4
7. How would you rate ICEO’s employer? (if applicable)
1 2 3 4
8. How would you rate your orientation?
1 2 3 4
9. How would you rate ICEO’s residents and local office assistance?
1 2 3 4
10. How would you rate ICEO’s emergency assistance system? (if applicable)
1 2 3 4
11. How would you rate communication with ICEO’s regional team? (if applicable)
1 2 3 4
12. How would you rate ICEO’s headquarter staff service(s)?
1 2 3 4
13. How would you rate the housing arrangements and assistance? (if applicable)
1 2 3 4
14. How would you rate the atmosphere in your work place(s)?
1 2 3 4
15. How would you rate your experience during the ICEO 12-month Work/Travel Pilot Program?
1 2 3 4
16. How would you rate the increase in your knowledge of the US, upon completion of the program?
1 2 3 4
17. How would you rate the entire administration of the ICEO 12-month Work/Travel Pilot Program?
1 2 3 4
18. How would you rate the cross-cultural activities available during your program?
1 2 3 4
19. What is the most important thing you have gained from participating in the ICEO 12-month Work/Travel Pilot Program?
20. Would you like to take part in the ICEO 12-month Work/Travel Pilot Program again?
yes no
21. Would you use the same overseas recruitment agency in your home country? (if applicable)
yes no
22. Would you recommend the ICEO 12-month Work/Travel Pilot Program to other candidates in your home country?
yes no
23. Would you say taking part in the ICEO 12-month Work/Travel Pilot Program was a valuable experience?
yes no
24. Please list 3 things that you would change about the ICEO 12-month Work/Travel Pilot Program and why: