2007-2008 Program and Performance Measurement Report
Schools and Districts
Please fill out this form completely.
The Program and Performance Measurement Report Registration Information (pages 2-3 of this form) should be completed by any organization receiving Learn and Serve funds (CNCS grantees, subgrantees, organizations receiving grants from subgrantees).
This Program Reporting Form (beginning on page 4) should be completed by:
(1) LSA grantees (such as direct higher education grantees) directly operating LSA funded service-learning programs;
(2) Any organization receiving a subgrant under the Learn and Serve America (LSA) program (i.e. a Learn and Serve grant awarded by a State Education Agency, Grantmaking Entity, or Higher Education Consortium); (3) By institutions receiving program grants from subgrantee organizations.
The questions on this form refer to the July 1, 2007 – June 30, 2008 program year. |
Public
reporting burden for this collection of information is estimated to
average 60 minutes per response, including the time for reviewing
instruction, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding this burden
estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Corporation
for National and Community Service, 1201 New York Avenue, NW,
Washington, D.C. 20525; and to the Office of Information and
Regulatory Affairs, Office of Management and Budget, Washington,
D.C. 20503.
Registration Form
Subgrantee ID number: (from grantee): |
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Organization/School Name: |
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School District (if applicable): |
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Program Name (if any): |
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Contact Person – First Name: |
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Street Address: |
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Zip+4: |
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Telephone: |
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Website (if any): |
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Alternate Contact Person: |
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Additional Contact Persons: |
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Please choose one of the descriptions below. Only fill out the ethnic description if you are a higher education organization and one applies.
K-12 |
Higher Education |
Community-Based Organization |
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School District |
2 Year Public College |
National
Not-for-profit |
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Regional Education Agency |
2 Year Private College |
State or Regional Not-for-Profit |
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State Education Agency |
4 Year Public College or University |
Local Not-for-Profit |
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4 Year Private College or University |
State service commission |
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Public School |
Graduate/Professional Program |
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Private School |
Higher Education Association/ Consortia |
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Public Charter School |
If checked above, secondary window asks for the following: “Is your college or university a:” |
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Indian/Tribal School |
Historically Black College/University |
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Hispanic Serving Institution |
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Tribal College/University |
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Is your institution religious or faith-based?
Yes No Don’t Know
Please indicate which of the following activities you performed during the 2007-2008 program year using Learn and Serve grant funds:
My institution or organization used Learn and Serve funds to provide training and technical assistance and/or curriculum development for service-learning activities |
Yes |
No |
My institution or organization subgranted Learn and Serve funds to other institutions or organizations |
Yes |
No |
My institution or organization ran Learn and Serve funded service-learning activities (Note: answering yes to this question indicates that you will report on participants and service-learning activities for this program year) |
Yes |
No |
If you provided subgrants, please list all of the institutions or organizations to which you make grants of Learn and Serve America funds. For each, please provide the name of the organization, the size of the grant, and contact information for the lead contact person for the programs. Please note, do not include mini-grants or grants to individuals within your institution, or small grants to individuals (for example, training stipends) in other institutions.
Institution/ Organization |
Grant Size (Dollars) |
Contact Person |
Address |
Telephone/ Fax |
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Program Reporting Form
The following questions are about your school/district.
Are you reporting on an individual school or a school district? (Note: If you are reporting for an individual school, answer all organizational questions based on the school; if you are reporting for a district, answer all organizational questions based on the district)
Individual School School District
What grade levels does your school/district include? Lowest grade _____ Highest grade _____
What percentage of your school/district’s students qualify for free/reduced lunch? _______%
Institution size: provide the number of students in your entire school/district
Total Number of Students |
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What best describes the scope of service-learning activities at your school/district during the 2007-2008 program year? Check all that apply.
District-based: Involving all the schools in the district |
School-based: School-wide (i.e., involving all students) |
District-based: All high schools |
School-based: Discipline-wide (for example, all social studies classes) |
District-based: All middle schools |
School-based: Grade-wide (i.e., involving all the classes or students in a grade) |
District-based: All elementary schools |
School-based: Multiple classrooms (but not grade or discipline-wide) |
District-based: Grade-wide (i.e. all classes in one or more specific grades) |
School-based: Single classroom |
District-based: A district-wide special purpose program (for example, all after-school programs or Special Education Programs) |
School-based: Co-curricular |
District-based: Multiple schools (more than one school, but not a full category of schools. For example, not all high schools or grade-wide.) |
Other (specify) |
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Don’t know |
Does your school/district have service-learning requirements for any of your students?
Yes, for all students
Yes, for some students
No (skip to question 8)
Don’t Know (skip to question 8)
If your school/district has a service-learning requirement for students, what type(s) of service-learning requirement(s) does your school/district have?
Required courses that incorporate service-learning |
Yes |
No |
Specific number of hours of service outside the classroom |
Yes |
No |
Some other requirement (specify__________________) |
Yes |
No |
2007- 2008 Learn and Serve Grant Amount (from grantee file link/lookup): $ __________
Is the current grant the first Learn and Serve America grant that your school/district has received?
Yes, this is the first grant
No, we have received prior grants
Don’t know
What are the other (non-Learn and Serve) sources of funding for your institution’s service-learning initiatives or programs this year? Please include any funds designated as match as well as other sources of funds used for service-learning. (check all that apply)
State service-learning funds (non-LSA) |
Community/private contributions (e.g., United Way) |
Other state grant or program funds |
Other Corporation for National and Community Service Grants |
General school or district operating funds |
Other federal funds (e.g., Safe and Drug-Free Schools, Title I) |
Foundation grants |
Other |
Corporate grants |
Don’t Know |
In this section we are interested in the individuals who participate in your LSA service learning programs and activities.
P
Note:
for the purpose of this survey, a
service-learning participant is a student, between the ages of 5
and 17, who is involved in service-learning programs or activities
that engage service-learners in learning activities, assessment and
reflection, and direct or indirect service to beneficiaries.
Service-learning programs and activities include preparation and
reflection, as well as direct service. Youth or adults engaged in
one-time volunteer activities, as well as beneficiaries of the
service-learning activities, should not be counted as
service-learning participants .
LSA Funded Service-Learning Participants
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Estimated Number of K-12 Students |
Total number of individual service-learners in LSA supported activities/programs at your institution |
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Grade Level of all LSA service-learning participants |
Estimated Number of K-12 Students |
K - 5rd grade |
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6th garde – 8th grade |
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9th grade – 12th grade |
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School dropouts |
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Grade unknown |
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Ethnic background of LSA service-learning participants |
Estimated Number of K-12 Students |
Hispanic |
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Non-Hispanic |
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Ethnicity Unknown |
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Racial background of LSA service-learning participants |
Estimated Number of K-12 Students |
American Indian or Alaska Native |
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Asian |
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Black or African American |
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Native Hawaiian or Other Pacific Islander |
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White |
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Two or more races |
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Race Unknown |
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Gender of LSA service-learning participants |
Estimated Number of K-12 Students |
Male |
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Female |
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Gender Unknown |
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LSA service-learning participants with disabilities |
Estimated Number of K-12 Students |
Service-learners with disabilities |
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Approximately how many K-12 youth volunteers (defined as youth 5-17 years old) were involved in LSA supported service activities (i.e. one-time volunteers or volunteers recruited for service-learning activities. (Do not include regular program participants reported above).
_______ Estimated number of youth volunteers Don’t Know
Approximately how many adult volunteers (defined as 18 or older) were involved in LSA supported service-related activities (i.e. one-time volunteers or volunteers recruited for service-learning activities. Do not include program staff/teachers).
_______ Estimated number of adult volunteers Don’t Know
14a. Approximately how many of these adult volunteers are Baby Boomers (defined as individuals born between 1945 and 1965, or between the ages of 41 and 61)?
_______ Estimated number of Baby Boomer volunteers Don’t Know
Youth Participants from Disadvantaged Circumstances
______ Estimated Number Don’t Know
IV. Beneficiaries
Yes No Don’t Know
(If Yes, proceed to 16a. If No or Don’t Know, proceed to 17)
16a. Approximately how many of the youth beneficiaries of your LSA supported activities belong to the following populations (categories are not exclusive):
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Estimated Number |
Don’t Know |
Economically disadvantaged youth |
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Foster children |
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Adjudicated youth |
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Children of incarcerated parents |
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Students who are disabled/ in special education |
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Approximately how many youth (ages 5-17) were mentored through your LSA supported service-learning activities?
_______ Estimated Number Don’t Know Do not have mentoring activities (skip to question 18)
17a. Approximately how many of those mentored are from disadvantaged circumstances?
_______ Estimated Number Don’t Know
Approximately how many youth (ages 5-17) were tutored through your LSA supported service-learning activities?
_______ Estimated Number Don’t Know Do not have tutoring activities (skip to question 19)
18a. Approximately how many of those tutored are from disadvantaged circumstances?
_______ Estimated Number Don’t Know
Approximately how many individuals received independent living services, including respite care, to help them live independently in their homes in community-based settings?
_______ Estimated Number Don’t Know Do not have independent living service activities
In this question we are trying to get information about the duration of the LSA programs and activities in your school/district and the amount of time students are engaged in preparation, reflection, and service. Please fill in the table below with the numbers of program participants and average hours of preparation and service. If you do not run projects for any of the three durations, check “Do Not Run.” If you don’t know the number of participants and average hours for any of the three durations, check “Don’t Know.”
Instructions for completing table on service hours
1. First, estimate the number of service-learning participants who were in service-learning programs of the durations listed in the table below from July 1, 2007 to June 30, 2008. If you have more than one activity or program, please combine them in reporting participant numbers and hours. The total number of participants for all durations should equal the total number of participants reported in question 11.
2. Next, for each of the project durations, calculate the average hours of preparation for the service and formal reflection per participant during or after the service and enter that figure in column 3. 3. Finally, enter the average number of hours of service for a participant. Enter that figure in column 4.
• Preparation activities might include conducting background research, collecting data, attending trainings, assembling materials, rehearsing parts, and meeting to plan project activities during and after class.
• Formal reflection activities might include classroom discussions, keeping a journal, writing an essay or a poem, and making a class presentation.
• Service might include a variety of activities, including the following: providing direct service to individuals (tutoring, assisting at a human services agency, working in a classroom, etc.); service projects addressing a community need (for example, cleaning a park, raising money for a local program, monitoring local water quality), or education and advocacy efforts such as presenting a play on a community issue, organizing or testifying at a public hearing, or preparing educational materials (brochures, posters, etc.) on a local issue.
Example 1. The “Plant a Tree Project” lasted 2 months and involved 60 students (see ‘a’ in the table below). The average student in this project spent 8 hours engaged in preparation for the service and in formal reflection activities during and after the service (see ‘b’). The service activity itself took approximately 2 hours per student (see ‘c’).
Example 2: The senior Civics Class is organized around a core service-learning program. It meets one hour, two days a week for one semester, and has 25 students (see ‘d’). Each student in this class spent 63 hours engaged in service-learning preparation for the service and formal reflection during and after the service (see ‘e’). The service activity itself was 10 hours (see ‘f’). (Calculation: 2 hours of class + 1 hour of preparation + .5 hours of formal reflection x 18 weeks = 63 hours per student; 10 hours of service per student).
Duration |
Do Not Run This Type of Program |
Number of Participants |
Average Hours of Preparation and/or Formal Reflection per Participant |
Average Hours of Service per Participant |
Do Not Know |
Programs and activities that last 2 months or less |
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a. 60 participants |
b. 8 hours each |
c. 2 hours each |
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Programs and activities that last for most or all of one semester or term |
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d. 25 students |
e. 63 hours each |
f. 10 hours each |
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Programs and activities that last for most or all of the whole school year |
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PLEASE FILL IN
Duration |
Do Not Run This Type of Program |
Number of Participants |
Average Hours of Preparation and/or Formal Reflection per Participant |
Average Hours of Service per Participant |
Do Not Know |
Programs and activities that last approximately 2 months or less |
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Programs and activities that last for most or all of one semester or term |
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Programs and activities that last for most or all of the whole school year |
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* If DO NOT KNOW – instruction will pop up: “If you do not know, please estimate the number of hours you expect someone to spend.”
Project Characteristics
To what extent are the following characteristics present in the Learn and Serve-funded service-learning programs in your school/district?
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Never |
Rarely |
Occasionally |
Frequently |
Always |
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Service-Categories
For each of the following service categories, fill in the percentage of your LSA-supported service-learning activities and/or programs that fall into the category. If you do not have any service activities in a given category, leave the % blank; do not enter “0.” For each category where activities take place, please check up to three of the most common types of service being conducted.
Community and Economic Development ____ % of service activities/programs
Civic/Community Organizing |
Food Production |
Thrift Store |
Community Clean-up |
Housing Referrals/Relocation |
Transportation Services |
Consumer Education |
Housing Rehabilitation/Construction |
Volunteer Recruitment |
Economic Revitalization/Improvement |
Small Business Development
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Workforce Development, including Adult Mentoring |
Financial Asset Development |
Technology Access and Training |
Other Economic and Community Development (specify) |
Disaster Recovery/Relief* ____ % of service activities/programs
Disaster Mitigation |
Disaster Recovery |
Other Disaster (specify) |
Disaster Preparedness |
Disaster Response |
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*If you have activities under Disaster Recovery/Relief, please answer questions 23 and 24 below
Education ____ % of service activities/programs
Adult Literacy |
ESL |
Service-Learning |
After School Programs |
GED |
Special Education |
Classroom Education - Elementary |
Job Preparedness |
Tutoring - Elementary |
Classroom Education – Middle School |
Library Services |
Tutoring – Middle School |
Classroom Education – High School |
Pre-Elementary Day Care |
Tutoring – High School |
Cultural Heritage |
School Preparedness including Head Start |
Other Education (specify) |
Environment ____ % of service activities/programs
Clean Air |
Environmental Protection |
Waste Reduction, Management, Recycling |
Clean Water |
Environmental Restoration |
Other Environment (specify) |
Energy Conservation |
Indoor Environment |
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Environmental Awareness |
Toxic Waste Management |
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Health/Nutrition _____ % of service activities/programs
Boarder Babies |
Health Screening |
Mental Health |
CHIOS/CHIPS |
HIV/AIDS |
Developmental Disabilities |
Congregate Meals |
Hospice/Terminally Ill |
Physical Disabilities Programs |
Delivery of Health Services |
Immunization |
Public Health |
Food Distribution/Collection |
In-Home Care |
Substance Abuse |
Health Education |
Maternal/Child Health Services |
Other Health/Nutrition (specify) |
Human Needs ____ % of service activities/programs
Adoption |
Safe Havens |
Transitional Housing |
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Crisis Intervention |
Social Services Planning and Delivery |
Other Human Needs (specify) |
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Homeless Assistance |
Social Services Community Coordination(specify) |
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Independent Living ____ % of service activities/programs
Adult Day Care/Senior Center |
Respite |
Senior Companionship |
Independent Living – Disabled |
Senior Center Program (Non-Residential) |
Other Independent Living (specify) |
Independent Living - Seniors |
Senior Citizen Assistance |
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Public Safety ____ % of service activities/programs
Accident Prevention |
Community Policing/Community Patrol |
Household Security |
Adult Abuse/Neglect |
Conflict Resolution/Mediation |
Legal Assistance |
Adult Offender/Ex-Offender Services/Rehabilitation |
Crime Awareness/Crime Avoidance |
Sexual Abuse/Rape |
Adult Safety Programs |
Family Violence |
Victim/Witness Assistance |
Animal Care/Humane Society |
Fire Prevention |
Other Public Safety (specify) |
Youth Development ____ % of service activities/programs
Child Abuse |
Gangs |
Teen Pregnancy/ Abstinence/Parent Support |
Children and Youth Safety |
Juvenile Justice |
Youth Leadership Development |
Delinquency |
Mentoring |
Other Youth Development (specify) |
Disaster Preparedness and Response Programs (please answer questions 23 and 24 if you had service-activities in disaster preparedness and response)
How many service-learning participants have been certified in disaster training during the 2007-2008 program year?
_______________ Number Don’t Know
How many local disasters did service-learning participants respond to during the 2007-2008 program year?
_______________ Number Don’t Know
Approximately how many community partners (community agencies, local government, businesses, etc.) were formally involved in managing and/or planning LSA supported service-learning activities with the school during this year, for example, serving on advisory boards or planning projects.
If you do not know the number of community partners, please check here and skip to question 26:
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Number of Organizations |
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Of the total number of partners, how many were: (NOTE: the following categories are mutually exclusive; the sum of the numbers reported for 25a – 25d should equal the total number provided above.) |
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25a. |
Regularly and actively involved in planning and managing LSA funded service-learning? |
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25b. |
Periodically involved in planning and/or managing LSA funded service-learning? |
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25c. |
Advised on LSA funded service-learning but were not directly involved planning or managing LSA funded service-learning? |
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25d. |
Served as only a service site? |
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25e. How many of the total number of partner agencies/organizations are faith based? _______ Don’t Know
Does your service-learning program have an advisory board? Yes No Don’t Know
If YES, then: How many partner organizations are represented on the advisory board? _____
How many new community partnerships were formed as a result of your current LSA funding? _______
Collaboration with OtherFederal Programs
With which of the following Corporation for National and Community Service or U.S. Department of Education sponsored programs does your LSA program collaborate? (Check all that apply)
AmeriCorps |
Upward Bound |
AmeriCorps*VISTA |
GEAR-UP |
Senior Corps (Foster Grandparents, Senior Companions, RSVP) |
None |
Federal Work-Study |
Don’t Know |
How many of the following types of program volunteers were involved in coordinating service-learning programs and activities on a regular or on-going basis at your institution? (NOTE: this include members and volunteers who are involved in your school/district even if your school/district is not the host organization.)
____ AmeriCorps |
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____AmeriCorps*VISTA |
None |
____ Senior Corps SaYes volunteer |
Don’t Know |
These questions are about all service-learning in your school/district.
How long have there been organized service-learning activities at your institution (e.g. regular, ongoing service-learning)?
One year or less
Two to five years
Six years or more
Don’t Know
Please indicate which policies listed below are in place in your institution. For each type of policy, please indicate Yes, No, or Don’t Know.
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Yes |
No |
Don’t Know |
Service-learning is recognized by the school/district as an improvement strategy in its strategic plan or improvement plan |
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Service-learning is part of the board approved course curriculum in at least one subject in at least one grade in the school/district. *(If yes, answer question 31) |
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Service-learning is part of the board approved course curriculum in at least one subject in every grade in the school/district. *(If yes, answer question 31) |
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Service-learning is part of the board approved course curriculum in at least one course that is a required for graduation. |
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Service-learning participants are formally recognized through the Presidential Freedom Scholarship or the President’s Volunteer Service Award |
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Information about the President’s Volunteer Service Award and other CNCS national service programs is provided to students |
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* If service-learning is part of the board approved course curriculum in one or more subjects for one or more grades, please indicate the subjects. Check all that apply.
Social Studies |
Foreign Languages |
Vocational/career Education |
Language Arts/English |
Art/Music/Theater |
Advisory Period |
Science |
Physical Education |
Gifted/ Talented |
Math |
Health |
Elective |
Computer Science |
Special Education |
Other |
During the past year, how many classes with service-learning activities in your school/district were created as result of the Learn and Serve funds?
__________ Estimated number of programs Don’t Know
During the past year, how many classes with service-learning activities were provided by your school/district overall?
__________ Estimated number of programs Don’t Know
Indicate the extent to which the following policies/practices were present at your school/district over the past year:
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Never |
Rarely |
Occasionally |
Frequently |
Always |
Service-learning is included in the school’s/district’s current professional development plans |
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The school/district has adopted and/or disseminated quality standards for service-learning (for example, the Essential Elements of Service-Learning) |
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Service-learning is included in new staff/teacher orientation |
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Service-learning is considered as one of the criteria for teacher/staff evaluations and/or in performance standards for teachers/staff |
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Students are involved in decision-making about the service-learning activities in the school/district, for example, through an advisory council or other formal planning or decision-making body |
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Parent and/or family volunteers help with service learning. |
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During the past year, to what extent were the following available at your institution? Please indicate how regularly or widely each type was available.
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Never |
Rarely |
Occasionally |
Frequently |
Always |
Financial support for planning, training, and implementation of service-learning projects or programs |
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Reduction in teaching load to allow time for service-learning program development or supervision |
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Technical assistance on planning or implementation of service-learning activities |
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Recognition or rewards for teachers/staff for quality service-learning practice |
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IX. Service-Learning Coordinator
The school has a full or part-time service-learning coordinator or staff person with responsibility for service-learning
Yes No (skip to question 43)
If there is a service-learning coordinator for the school/district, how many years of professional experience has the coordinator had with service-learning (for example, as a coordinator, teacher, etc.)? If more than one coordinator, please provide information on the primary coordinator.
Less than 1 year 1-4 years 5 years or more
Is the service learning coordinator a full time or part-time employee of the school/district?:
Full-time
Part-time
Approximately what percentage of the coordinator’s total job responsibilities is service-learning?
100 % 50%
75 % 25% Less than 25%
Please select the answer that best describes the extent of training/professional development the service-learning coordinator has received.
No formal education/training/professional development related to service-learning
One workshop, conference, or training session
Multiple workshops/conferences/training sessions, OR one or more semesters of formal education (pre-service or in-service) focused on service-learning
A
combination of a semester or more of formal education and multiple
workshops/training sessions..
What percentage of the service-learning coordinator’s salary is from grants and institutional funds in 2007-2008 (including LSA funds):
Grants _____%
Institutional funds _____%
X. Program Description
Please provide a brief (100-150) word description of one service-learning project or activity funded by the current LSA subgrant. In doing so, please make sure you answer the following questions: What is the purpose of the project? What are the academic or educational goals? Where and when does it take place? Who are the participants? Who are the beneficiaries of the service? What are the intended results?
Please provide information on any training, technical assistance or curriculum development that your organization conducted during the 2007-2008 program year that was supported by Learn and Serve funds.
How many teachers, staff and/or students received technical assistance through your LSA-funded technical assistance programs during the 2008 program year?
_______________ Number Don’t Know
How many teachers, staff and/or students have attended the LSA-supported trainings that you provided during the 2008 program year? (NOTE: trainings can be in-person, via telephone, or web-based)
_______________ Number Don’t Know
How many training and technical assistance and/or curriculum products (e.g. training manuals, lesson plans, assessment tools) were created?
_______________ Number Don’t Know
Please provide a brief description (100-150 words) of the training and technical assistance and/or curriculum development activities that were supported by Learn and Serve funds. The description may include any special initiatives that you introduced, areas covered by training and technical assistance, and subject or service areas for curricula developed, as well as the number and type of school, teachers, staff, and students involved in these activities.
This information may be used to plan peer to peer training.
In which of the following areas do you believe your organization/program is particularly strong and capable of providing technical assistance to other Learn and Serve programs? Please check all that apply.
Program Management |
Program Content |
Program Design Strategic Planning Developing Community Partnerships Assessing community impact Building Community/Institutional Support Service Site Recruitment Volunteer/service site training Staff development/teacher education Managing/Overseeing Service Sites Program evaluation strategies/Performance measurement Financial/grant management Marketing Other (specify) ________________________ None |
Curriculum/program design (specify subject area) Development/Leadership Orientation Reflection techniques Youth voice/youth governance Individual assessment strategies (portfolios, etc.) Promotion and tenure Other (specify) _____________________ None
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In which of the following areas do you think your organization/program is most in need of technical assistance or training? Please check the three highest priority areas for assistance.
Program Management |
Program Content |
Program Design Strategic Planning Developing Community Partnerships Assessing community impact Building Community/Institutional Support Service Site Recruitment Volunteer/service site training Staff development/teacher education Managing/Overseeing Service Sites Program evaluation strategies/Performance measurement Financial/grant management Marketing Other (specify) ________________________
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Curriculum/program design (specify subject area) Development/Leadership Orientation Reflection techniques Youth voice/youth governance Individual assessment strategies (portfolios, etc.) Promotion and tenure Other (specify) _____________________________ |
OMB Control Number 3045-0089
File Type | application/msword |
File Title | 2003-2004 Program Reporting and Performance Measurement Form |
Author | Alan Melchior |
Last Modified By | Kimberly Spring |
File Modified | 2007-07-17 |
File Created | 2007-07-12 |