Form 2 LASSIE Survey Summer of Service

2010 Program and Performance Measurement Report

Summer of Service

Please fill out all relevant sections of this form completely.

The Grant Profile Information (pages 3-4 of this form) should be completed by any organization receiving Learn and Serve America funds (grantees, subgrantees, organizations receiving grants from subgrantees).

The Program Reporting Form (beginning on page 5) should be completed by Learn and Serve America grantees, subgrantees, and sub-subgrantees that directly operate Learn and Serve America supported service-learning programs and/or service-learning training and technical assistance activities. Respondents will be directed to the relevant sections of the Program Reporting Form based on their responses to the Grant Profile section.

The questions on this form refer to the April 1, 2010 – September 30, 2010 Summer of Service program period.

Public Burden Statement: The Paperwork Reduction Act of 1995 requires the Corporation to inform all potential persons who are to respond to this collection of information that such persons are not required to respond unless it displays a currently valid OMB control number (See 5 CFR 1320.5(b)(2)(i).

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.

Privacy Act Statement

AUTHORITY: In accordance with the Privacy Act of 1974 (5 U.S.C § 552a) the following information is provided.

PURPOSE: The primary purpose of the user account is to provide a means for the Corporation for National and Community Service to collect and report on the activities of Learn and Serve America funded-programs. The collection of this information is authorized by the National and Community Service Act, as amended by the National and Community Service Trust Act of 1993.

ROUTINE USES: These routine purposes may include disclosure of the information to federal, state, or local agencies pursuant to lawfully authorized requests.

• All information collected will be made available to the Corporation, any intermediary grantor of your Learn and Serve funds, if applicable, and federal, state, or local agencies pursuant to lawfully authorized requests;

• Used as a basis for summaries, briefings, or responses to Members of Congress or other agencies in the Executive Branch of the Federal Government;

• Provided to Congress or other Federal, State, and local agencies, when determined necessary.

MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING INFORMATION:

All non-personally identifiable information may be provided to the public. Personally identifiable information will not be provided to any other organizations without your prior written permission.

Additionally, disclosure of LASSIE data through the Open Government Initiative will be available to the public.

ACKNOWLEDGMENT:

I understand the provisions of the Privacy Act of 1974 as related to me through the foregoing statement.

Grant Profile

Organization

Grant ID number: PREASSIGNED

Organization/School Name:

Organization/School Nickname:

Grant Amount: PROVIDED BY GRANTING INSTITUTION

Organization Location

School District (if applicable):

Website (if any):

Street Address 1:

Street Address 2:

City:

State:

Zip plus four:

Contacts (You may enter additional contacts as needed)

Primary Contact Person:

Prefix:

First Name:

Last Name:

Title:

Email:

Telephone:

Fax:

1. Select the organizational type that best describes your organization.

K-12 District	Higher Education		Community-Based Organization
 School District	 2 Year Public College		 Local Nonprofit
 Regional Education Agency	 2 Year Private College		 State or Regional Nonprofit
 State Education Agency	 4 Year Public College or University		 National Nonprofit
K-12 School	 4 Year Private College or University		 State Service Commission
 Public School	 Graduate/Professional Program
 Private School	 Higher Education Association
 Public Charter School
 Indian/Tribal School

1a. If you are a higher education institution, please indicate if your college or university is a: (Definitions of the following institution types can be found in the US Department of Education’s Higher Education Act)

 Historically Black College/ University	 Native-American Serving (Non-Tribal) Institution	 Alaska Native Serving Institution
 Predominately Black Institution	 Tribally Controlled College/University	 Asian American and Pacific Islander Serving Institution
 Hispanic Serving Institution	 Native Hawaiian Serving Institution	 Predominately Minority Population Community College

2. Is your organization religious or faith-based?

 Yes  No  Don’t Know

3. Please indicate which of the following activities you performed as part of the Learn and Serve America 2010 Summer of Service program:

My institution or organization ran Learn and Serve America supported service-learning activities. (Note: Answering yes to this question indicates that you will report on participants and service-learning activities for this program year.) [Positive respondents are directed to complete questions 1-12 of the Program Reporting Form.]	 Yes	 No
My institution or organization used Learn and Serve America funds to provide training and technical assistance and/or curriculum development for service-learning activities. [Positive respondents are directed to complete questions 13-17 of the Program Reporting Form.]	 Yes	 No
My institution or organization subgranted Learn and Serve America funds to other institutions or organizations. [Positive respondents are directed to complete question 5 of the Grant Profile.]	 Yes	 No

4. Would you like to enable E-Worksheets? The E-Worksheets function is an optional tool for administrators and facilitators to maintain electronic records for certain collected data elements of the survey (e.g. participant counts and demographics). E-Worksheets can be sent to service-learning providers to record details on the service-learning activities. Data collected from E-Worksheets can be reviewed and automatically imported into your survey. For more information on the E-Worksheets, visit the LASSIE on-line help page.

 Yes  No

5. 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)	Address	Contact Person	Telephone/ Fax	Email

End of Grant Profile Questions

Program Reporting Form

I. Service-Learning Participants and Teachers/Staff

In this section we are interested in the individuals who have participated in Learn and Serve America supported service-learning programs and activities.

1. Please provide demographic information on the service-learners who were engaged in Learn and Serve America supported activities from April 1, 2010 to September 30, 2010. If you have no students in a given category, enter “0” in the relevant box. Note that service-learners in the Learn and Serve Summer of Service program are entering into grades 6-9 in the school year following participation in the program.

Note: for the purpose of this survey, a service-learner is a youth, between the ages of 5 and 17, who participates in service-learning programs or activities that engage him or her 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-learners.

Learn and Serve America Supported Service-Learners	Estimated Number of Service-Learners
Total number of individual service-learners in Learn and Serve America supported activities/programs

Grade Level of Learn and Serve America Service-Learners (Note: Grade level is the grade they will enter in the following school year)	Estimated Number of Service-Learners
6th grade – 8th grade
9th grade – 12th grade
School dropouts
Grade unknown

Ethnic Background of Learn and Serve America Service-Learners	Estimated Number of Service-Learners
Hispanic
Non-Hispanic
Ethnicity Unknown

Racial Background of Learn and Serve America Service-Learners	Estimated Number of Service-Learners
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Two or more races
Race Unknown

Gender of Learn and Serve America Service-Learners	Estimated Number of Service-Learners
Male
Female
Gender Unknown

Learn and Serve America Service-Learners with Disabilities	Estimated Number of Service-Learners
Service-learners with disabilities

Learn and Serve America Service-Learners from Economically Disadvantaged Circumstances	Estimated Number of Service-Learners
Service-learners who are eligible for free or reduced price lunch

Teacher/Staff Participation in Service-Learning

2. How many teachers and staff were involved in teaching, leading, and operating Learn and Serve America supported service-learning programs in the Summer of Service program? Count each teacher and staff, regardless of part-time or full-time status.

_______ Total number of teachers and staff

Additional volunteers

3. Approximately how many K-12 youth volunteers (defined as youth 5-17 years old) were involved in Learn and Serve America supported service activities (i.e. one-time volunteers or volunteers recruited for service-learning activities). Do not include regular service-learners reported above.

_______ Estimated number of youth volunteers  Don’t Know

4. Approximately how many adult volunteers (defined as 18 or older) were involved in Learn and Serve America supported service-related activities (i.e. one-time volunteers or volunteers recruited for service-learning activities). Do not include staff and teachers reported above.

_______ Estimated number of adult volunteers  Don’t Know

4a. Approximately how many of these adult volunteers are 55 years or older?

_______ Estimated number of adult volunteers 55 and older  Don’t Know

II. Program Duration and Service-Learning Characteristics

5. T

   NOTE: The reporting of hours here is separate from the record-keeping necessary for students to be eligible for the education award. The recording and verification of service hours for the education award must be done through the Member Portal.

   his question is designed to gather information on the amount of time youth are engaged in preparation, reflection, and service during the Summer of Service program. Please fill in the table below with the number of service-learners and average hours of preparation and service. If you don’t know the number of participants and average hours, check “Don’t Know.”

Instructions for completing table on service hours

1. First, select the number of service-learners who were in the Summer of Service program from April 1, 2010 to September 30, 2010.

2. Next, 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. The “House Weathering Project” lasted 3 months and involved 75 students (see ‘a’ in the table below). The average student spent 25 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 100 hours per student (see ‘c’).

EXAMPLES

Duration	Number of Service-Learners	Average Hours of Preparation and/or Formal Reflection per Service-Learner	Average Hours of Service per Service-Learner	Do Not Know
Summer of Service program	a. 75 youth	b. 25 hours each	c. 100 hours each

PLEASE FILL IN

Duration	Number of Service-Learners	Average Hours of Preparation and/or Formal Reflection per Service-Learner	Average Hours of Service per Service-Learner	Do Not Know*
Summer of Service program

* If DO NOT KNOW – instruction will pop up: “If you do not know, please estimate the number of hours you expect someone to spend.”

III. Project Characteristics

6. How often are the following characteristics present in the Learn and Serve America supported service-learning projects in the school?

	Never (0%)	Less than 50% of the time	More than 50% of the time	Always (100%)	N/A
Service-learners participate in a community needs assessment to plan the service-learning project					
The service-learning activities are of a sustained and significant duration (i.e. concentrated blocks of time over a period of several months)					
The learning objectives for the service-learning activities are aligned with the academic curriculum					
The service-learning activities are included in student records					
Community partners collaborate in setting goals and establishing an action plan					
Service-learners generate ideas and make decisions on the design and implementation of the service-learning project					
Service-learners present their findings from the service-learning project to community members					
Service-learners engage with diverse perspectives through the service-learning project					
Service-learners examine the broader social and civic context for the identified community need					
The project includes a variety of reflection activities that examine changes in service-learners’ knowledge and attitudes					
Service-learners measure their progress toward meeting specific service goals and learning outcomes during the project					
The service activities present opportunities for the participants to apply newly acquired skills and knowledge to a community need					

IV. Community Needs and Service Activities

Community Needs

7. This question is designed to gather information on the types of community needs that the Learn and Serve America supported service-learning activities have been designed to address. The community needs have been categorized into the two general issue areas identified for the 2010 Summer of Service programs. For each issue area, provide the percentage of the service-learning activities that address the relevant issue area. If there are no service activities that address a given area, leave the % field blank (do not enter “0”). For each area with activities, check up to three of the most common types of community needs being addressed by the activities.

Disaster Recovery and Relief ____ % of service activities/programs

 Disaster Mitigation	 Disaster Recovery	 Other Disaster (specify)
 Disaster Preparedness	 Disaster Relief

Environment and Energy ____ % of service activities/programs

 Clean Air	 Environmental Protection	 Weatherization
 Clean Water	 Environmental Restoration	 Other Environment (specify)
 Energy Conservation	 Indoor Environment
 Environmental Awareness	 Waste Reduction/Recycling

Service Activities

8. (For the most common issue area, or the issue area with the highest percentage of activities in question 7) Please provide a brief description (200 word limit) the specific service-learning activities that were used in addressing the community need. In the description, include the goals of the project, the participants and beneficiaries involved, the location of the service-learning activities, and any measured outcomes.

(Note: If desired, you may provide activities for more than one need.)

V. Community Partners

The following questions are designed to gather information on the community partners (community agencies, schools, local government, businesses, etc.) that were formally involved in managing, planning, and/or implementing Learn and Serve America supported service-learning activities during the 2010 Summer of Service program period.

9. How many community partners were involved in Learn and Serve America supported service-learning activities?

_______  Don’t Know

9a. Of the total number of partners, how many served as a service-learning placement site?

_______  Don’t Know

9b. Of the total number of partners, how many are faith-based organizations?

______  Don’t Know

9c. Of the total number of partners, how many provide in-kind or cash support for service-learning?

______  Don’t Know

10. Does the service-learning program have an advisory board?

 Yes  No  Don’t Know

10a. If YES, do one or more of the community partners serve as members of the advisory board?

 Yes  No  Don’t Know

Collaboration with Other Federal Programs

11. Which of the following Corporation for National and Community Service programs collaborated with the Summer of Service program implementing service-learning activities? (Check all that apply)

 AmeriCorps	 Senior Corps
 AmeriCorps*VISTA	 None
 AmeriCorps*NCCC	 Don’t Know

12. Which of the following other federal programs collaborated with the Summer of Service program in implementing the service-learning activities ? (Check all that apply)

 Career and Technical Education	 GEAR-UP	 Other (specify)
 Character Education	 21st Century Learning Centers	 None
 Federal Work Study	 Upward Bound	 Don’t Know

VI. Training and Technical Assistance (Only for those who indicated that they provided training and technical assistance under question 3 of the Registration Form)

Please provide information on the training and technical assistance that your organization provided during the Learn and Serve America 2010 Summer of Service.

13. How many teachers, faculty and/or staff participated in training and technical assistance activities that were supported by the Learn and Serve America 2010 Summer of Service?

_______Number  None  Don’t Know

14. [If respondent reported teachers, faculty and/or staff in 13] How many teachers, faculty and/or staff participated in each of the following types of training and technical assistance activities?

	Number	Don’t Know
1-day in-person service-learning institute		
In-person service-learning institute that lasted more than one day		
Webinars		
Discussion lists, wikis, and other forums for electronic collaboration		
In-person meetings with representatives of community partner organizations		
Opportunities to participate in Professional Learning Communities		
Opportunities to work with a mentor who has experience using service-learning		
Opportunities to take part in service-learning projects as participants/service-learners		

15. How many college students participated in training and technical assistance activities that were that were supported by the Learn and Serve America 2010 Summer of Service?

_______ Number  None  Don’t Know

15a. How many of the college students that participated in training and technical assistance activities were pre-service teachers?

_______ Number  None  Don’t Know

16. [If respondent reported college students in 15] How many college students participated in each of the following types of training and technical assistance activities?

	Number	Don’t Know
1-day in-person service-learning institute		
In-person service-learning institute that lasted more than one day		
Webinars		
Discussion lists, wikis, and other forums for electronic collaboration		
In-person meetings with representatives of community partner organizations		
Opportunities to participate in Professional Learning Communities		
Opportunities to work with a mentor who has experience using service-learning		
Opportunities to take part in service-learning projects as participants/service-learners		

17. Please provide a brief description (100-150 words) of the training and technical assistance activities that were supported by the Learn and Serve America 2010 Summer of Service. 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.

OMB Control Number 3045-0089