WIRED Initiative Evaluation, screener, local governments

ETA-9146 OMB Control No. 1205-0NEW

Expiration Date xx/xx/20xx

REGIONAL TRANSFORMATION

SCREENER SURVEY

This survey is designed to collect information about efforts to increase collaboration in your community between research, education, economic development and workforce development systems. The U.S. Department of Labor has provided funding to support such collaboration, through the Workforce Innovation in Regional Economic Development (WIRED) Initiative, in order to increase your community’s economic competitiveness in the global marketplace. This survey is intended to assess the degree and type of collaboration between partners and other stakeholders that is taking place in your region.

Disclosure Statement

Your responses will help us better understand these collaborative efforts. Individual responses will not be attributed to specific individuals or organizations. Responses to this data collection will be used only for statistical purposes. The reports prepared from this survey will summarize findings across the sample and individual forms will not be available to anyone outside the study team, except as required by law.

Public Burden Statement

According to the Paperwork Reduction Act of 1995, persons are not required to respond to this collection of information unless it displays a currently valid OMB control number and expiration date. Responding to this questionnaire is voluntary. Public reporting burden for this collection of information is estimated to average 5 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.. Send comments regarding this burden estimate to the U.S. Department of Labor, Office of Policy Development and Research, Room N5641, 200 Constitution Avenue, NW, Washington, D.C. 20210.

Do NOT send the completed questionnaire to this address.

ID: G R R T T n n n

Note: G = Generation

RR = Region

TT = Organization type (may change)

nnn = respondent number

Instructions. This short questionnaire has been sent to you as part of an evaluation of the U.S. Department of Labor’s Workforce Innovation in Regional Economic Development (WIRED) Initiative, which is supporting regional transformation of economic, education and training activities in your community. One of the purposes of the survey, which is being sent to individuals who hold positions similar to yours in the region, is to gauge your familiarity with efforts to transform your community’s economic, education, philanthropic, and workforce investment systems. The survey should take you approximately five (5) minutes to complete. Thank you in advance for your time.

Should you have any questions or comments about this survey, please contact:

[[Contact’s name and telephone/email address.]]

Organization Type: We have sent you this survey because our information indicates that you are a decision maker in the following type of organization: ______________________. If our information is incorrect, please cross off the wrong organization type and mark the correct one.

Industry ______

Government/Nonprofit ______

Education ______

Workforce development ______

Economic Development ______

Funding Organizations ______

Union Representative______

Other ______. Please describe ________________________________________________

Instructions. Use the following scale to answer the questions below:

0 1 2 3

None Little Somewhat A Great Deal

1. How aware are you of efforts in your community or region to transform economic, education, and workforce investment systems through increased collaboration?

______

2. How actively has your organization been engaged in the transformative efforts referred to in question 1? ______

IF ANSWER IS 0 OR 1, GO TO 2a. IF ANSWER IS 2 OR 3, GO TO 2b.

2a. Even though your organization may not be actively involved, these efforts may be affecting your organization or how you do business. To what extent are regional efforts to bring about regional economic transformation influencing your organization, if at all? ______

If answer is 1, 2, or 3, please explain and then skip to Question 2b?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

If Answer is 0, GO TO 3.

2b. Who in your organization (including yourself) would be appropriate to provide information about your organization’s involvement in regional transformation? (We will send this individual a follow-up survey.)

Name: _________________________________________________

Position in Organization:___________________________________

E-mail: _________________________________________________

Address: _______________________________________________

_________________________________________________

Phone:________________________________

Fax:______________________________

2. Do you have any comments about efforts to achieve economic transformation in your region that might be of value in the evaluation?

THANK YOU.