0 mini grantee

OMB No. 0970-0297

Expiration Date: 1/31/09

Compassion Capital Fund Evaluation

Survey of Faith-based and Community Organizations

The U.S. Department of Health and Human Services, Administration for Children and Families, is conducting a study to examine the benefits of the Targeted Capacity Building Program (mini-grants) funded through the Compassion Capital Fund (CCF).

As part of this study, we are surveying organizations such as yours that received mini grants in both 2003 and 2004. Your organization was selected randomly from the grantees operating during this period to represent the faith-based and community organizations that received such assistance.

Your participation in completing this survey will greatly benefit both the Compassion Capital Fund program and Federal government in general. Information you provide will assist the Department of Health and Human Services in assessing and improving the CCF program. All information obtained through this survey will be kept confidential to the extent provided by law. Information provided in this survey will be accessed solely by staff at Branch Associates, the research firm responsible for conducting this evaluation of the Compassion Capital Fund. Results of the study will be reported in aggregate only. Completing this survey is voluntary.

Instructions:

Please complete the following questions to help us evaluate the CCF program. Please answer each of the questions in this survey about the primary recipient of the mini grant award. Throughout this questionnaire, the primary recipient will be referred to as “your Organization.”

Please make a copy of the completed survey for your records and reference if we need to talk with you to clarify any responses.

Please return the completed survey in the enclosed pre-stamped envelope by (date).

Thank you for your time in completing this survey!

Y

ID #

our name:

Your business telephone number:

1. Name of your Organization:

Complete address of your Organization

Street:

City/State:________________________________________________________________

Zipcode:________________

Organization Telephone No:______________________________________

Email address: __________________________________________

2. Check the box that best describes your Organization:

₁ Faith-based organization ₂ Secular organization

3. What is/are your Organization’s primary programmatic area(s)? (Check all that apply. If more than 3 areas are checked, circle the “P” to indicate the 3 largest program areas.)

1	P	Abstinence	8	P	Homelessness/housing assistance
2	P	At-risk youth/children and youth services	9	P	Hunger
3	P	Drug and alcohol rehabilitation	10	P	Job training/welfare-to-work
4	P	Economic/community development	11	P	Marriage/relationships
5	P	Education/training	12	P	Prison ministry or prisoner reentry services
6	P	Elderly/disabled services	13	P	Services to immigrants (including ESL)
7	P	Health Services (including HIV/AIDS/pregnancy)	14	P	Social services to rural communities
			15	P	Other (Specify:) _ __________________________

4. Please indicate the year(s) in which your Organization received a CCF Targeted Capacity Building award (mini-grant award) and the total amount of the award.

Grant Cycle		Amount of Mini-Grant Award
I: September 2002 - September 2003		$_____________________
II: September 2003 - September 2004		$_____________________
III: September 2004 - September 2005		$_____________________

5. Please indicate whether your Organization also received customized one-on-one technical assistance, training or sub-award(s) to support organizational capacity building from a CCF-funded intermediary during any of the following time periods?

Time Period	Received one-on-one, customized technical assistance	Received financial assistance or sub-award	Received training (i.e. classes, workshops)
I: September 2002 – September 2003	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No
II: September 2003 – September 2004	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No
III:September 2004 – September 2005	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No

5a. If yes, please provide the name of the intermediary __________________________

6. Please indicate whether your Organization received customized one-on-one technical assistance, training or financial assistance to support organizational capacity building from any other agency/organization (that was not funded through CCF) during any of the following time periods?

Time Period	Received one-on-one, customized technical assistance	Received financial assistance or sub-award	Received training (i.e. classes, workshops)
I: September 2002 - September 2003	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No
II: September 2003 – September 2004	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No
III: September 2004 – September 2005	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No

The remainder of this survey is focused on learning how the mini-grant affected your organization.

7. Did the mini-grant enable your Organization to serve more clients?

₁ No (Proceed to # 8)

₂ Yes  Indicate the estimated number of additional clients and explain in what way the organization was able to serve more clients: #_____________

Explanation:

7a. If yes, was your Organization able to sustain this number of clients after the mini-grant funds ran out?

₁ No

₂ Yes  Please explain how your organization sustained the increased number of clients:

8. Did the mini-grant enable your Organization to hire more staff?

₁ No (Proceed to # 9)

₂ Yes  Indicate the total number of additional staff; #_______

#____part-time and/or #___ full-time

Please describe the types of staff (indicate whether in administrative roles or worked directly with participants/clients in your Organization’s program):

8a. If yes, was your Organization able to sustain this increase in staffing levels after the mini-grant funds ran out?

₁ No

₂ Yes  Please explain how your organization sustained the increased number of staff:

9. Did the mini-grant enable your Organization to start a new program?

₁ No (Proceed to # 10)

₂ Yes  Indicate the type of program and number of individuals served: #

9a. If yes, was your Organization able to sustain this new program after the mini-grant funds ran out?

₁ No

₂ Yes  Please explain how your organization sustained the new program:

_________________________________________________________

10. Use the chart below to describe your Organization’s grant writing and fundraising activities related to each of the funding sources listed in the first column prior to the receipt of the mini-grant award and since the receipt of the mini-grant.

	Prior to receipt of mini-grant award		Since receipt of mini-grant award
Funding Sources	Had your Organization applied for funding?	Had your Organization obtained funds?	Has your Organization applied for funding?	Has your Organization obtained funds?	How many applications has your Organization submitted to this source?	How many applications have been funded?	What has been the total amount of funding from this source?
1. from Federal government agencies	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No	#: ________	#: ______	$_______
2. from non-federal government agencies (state, local)	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No	#: ________	#: ______	$_______
3. from Foundations	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No	#: ________	#: ______	$_______
4. from other federated giving groups (e.g., United Way)	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No	#: ________	#: ______	$_______
5. from other funding sources (Specify:)	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No	1 Yes 2 No	#: ________	#: ______	$_____

11a. Check the appropriate boxes to indicate if the mini-grant award helped strengthen your Organization in the following areas:	11b. If you checked “yes” in the first column, please complete this column, checking boxes next to any specific ways these changes were achieved. If changes were achieved in another way, please describe:
1. Increased access to technology Yes No	1 Obtained computers and related hardware and software necessary to manage the organization 2 Obtained access to high-speed Internet 3 Trained staff in use of technology (e.g., spreadsheet skills) 4 Developed individual email/voicemail accounts for staff 5 Other:________________________________________ 6 Don’t know
2. Improved facilities or equipment Yes No	1 Purchased or leased additional space 2 Renovated space 3 Purchased equipment/supplies (specify:) ________________________________________________________________________________________________________________________________________________ 4 Other:________________________________________ 5 Don’t know
3. Improved organization’s governance Yes No	1 Established Board of Directors 2 Defined roles and responsibilities for Board members 3 Recruited new Board members to increase diversity and effectiveness of Board 4 Established Board committees to accomplish goals 5 Developed formal orientation for new Board members 6 Other:________________________________________ 7 Don’t know
4. Improved organization’s ability to manage its finances Yes No	1 Developed systems for recording financial transactions and generating regular (monthly, quarterly) budgets 2 Developed systems for tracking income and expenses 3 Developed systems for managing cash flow 4 Adopted a computerized bookkeeping system 5 Began using new financial software (e.g., Quickbook) 6 Instituted internal controls to improve oversight of finances 7 Hired CPA to conduct independent audit 8 Other:_______________________________________ 9 Don’t know
5. Increased ability to seek/diversify funding sources or resources Yes No	1 Obtained 501(c)(3) status 2 Hired grant writer 3 Developed fund-development plan 4 Applied for the first time for funding from a new funding source (specify source:) ___________________ 5 Other: (e.g., obtained in-kind donations from new source) ____________________________________________ 6 Don’t know
6. Increased ability to do effective long-term planning Yes No	1 Developed or refined a written mission statement 2 Gathered information from constituents to inform strategic decisions 3 Developed a written workplan for implementing long-range and annual goals and objectives 4 Created or updated a written strategic plan 5 Other:________________________________________ 6 Don’t know
7. Developed system for tracking outcomes Yes No	1 Began collecting basic information about program clients 2 Developed an automated system for tracking information about clients and program services 3 Identified specific key outcomes for program and began collecting outcome data on an ongoing basis 4 Began tracking long-term outcomes 5 Other: _______________________________________ 6 Don’t know
8. Other (explain:) ______________________________________________________________	Describe:

12. Think about the changes undergone at your Organization since the receipt of the mini-grant:

	Not at all	Very little	Somewhat	To a great extent
1. To what extent did the mini-grant make a positive difference in your Organization’s overall organizational capacity?	1	2	3	4
2. To what extent did the mini-grant make a positive difference in your Organization’s overall financial status?	1	2	3	4
3. To what extent did the mini-grant make a positive difference in the level or quality of your Organization’s provision of services to individuals/families?	1	2	3	4
4. To what extent did the mini-grant likely lead to improved outcomes for the participants your Organization serves?	1	2	3	4

13. Please indicate the primary ways the mini-grant funds were used and indicate estimated percentage of mini-grant funds spent on those functions

__ pay salary for a staff position __ estimated % of grant spent on this item

__ pay for consultant service (training, technical assistance, grant writing) __ estimated % of grant spent on this item

__ pay for facilities related costs (renovation, rent, etc) __ estimated % of grant spent on this item

__ pay for equipment/supplies (computers, telephones, desks) __ estimated % of grant spent on this item

__ pay for travel to conferences or training __ estimated % of grant spent on this item

__ other (explain)___________________________________ __ estimated % of grant spent on this item

_________________________________________________

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