3 LASSIE Survey YEZ

2010-2011 Program and Performance Measurement Report

Youth Engagement Zone Program

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 October 1, 2010 – June 30, 2011 program year.

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		 National Nonprofit Organization
 Regional Education Agency	 2 Year Private College		 State or Regional Nonprofit
 State Education Agency	 4 Year Public College or University		 Local 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 during the 2010-2011 program year using Learn and Serve America grant funds:

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 1-32 of the Program Reporting Form.]	 Yes	 No
My institution or organization used Learn and Serve America funds to provide (directly or through a third party) training and technical assistance for service-learning activities. [Positive respondents are directed to complete questions 33-36 of the Program Reporting Form.]	 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

End of Grant Profile Questions

Program Reporting Form

I. Zone Questions

1. How many secondary schools are included the Youth Engagement Zone?

_____ Secondary schools

2. What grade levels are included in the secondary schools with Youth Engagement Zone service-learning activities?

Lowest grade _____ Highest grade _____

3. On average, what percentage of students in the secondary schools is qualified for free or reduced price lunch?

_______%

4. Institution size: provide the total number of students in all of the secondary schools included in the Youth Engagement Zone.

Total Number of Students

5. Approximately what percentage of students in the secondary schools was actively engaged in service-learning activities during the 2010-2011 program year? Include all service-learning activities whether or not they were supported by Learn and Serve America grant funds.

 Less than 10%

 10-49%

 50-89%

 90-99%

 100%

 Don’t Know

II. Service-Learning Participants

In this section we are interested in the individuals who participate in service-learning programs and activities supported by the Youth Engagement Zone grant.

6. P

   Note: For the purpose of this survey, a service-learner is a secondary school student or out-of-school youth (defined as an individual who has not attained the age of 27, is not enrolled in school, and has not completed college or its equivalent) 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.

   lease provide demographic information on the service-learners who were engaged in Learn and Serve America supported activities from October 1, 2010 to June 30, 2011. If you have no service-learners in a given category, enter “0” in the relevant box.

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	Estimated Number of Service-Learners
K - 5th grade
6th grade – 8th grade
9th grade – 12th grade
School dropouts
Grade unknown
Out of school youth (excluding school dropouts reported above)

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 Serving in Summer Service-Learning Programs	Estimated Number of Service-Learners	Do Not Have Summer Programs
Service-learners serving in summer programs		

Teacher/Staff Participation in Service-Learning

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

_______ Total number of teachers and staff

Additional volunteers

8. Approximately how many 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

9. 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 regular service-learners, teachers and staff reported above.

_______ Estimated number of adult volunteers  Don’t Know

9a. Approximately how many of these adult volunteers are 55 years or older?

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

III. Beneficiaries

10. How many youth from disadvantaged circumstances received services through the Learn and Serve America supported service-learning activities during the 2010-2011 program year? Youth from disadvantaged circumstances are defined as those youth who are economically disadvantaged and one or more of the following: (a)are out-of-school, including out-of-school youth who are unemployed; (b) are in or aging out of foster care; (c) have limited English proficiency; (d) are homeless or have run away from home; (e) are at-risk to leave secondary school without a diploma; (f) are former juvenile offenders or at risk of delinquency; (g) are individuals with disabilities.

______ Estimated Number  Don’t Know

11. Approximately how many youth (ages 5-17) were mentored through your Learn and Serve America supported service-learning activities?

_____ Estimated Number  Don’t Know  Do not have mentoring activities (skip to question 12)

11a. Approximately how many of those mentored are from disadvantaged circumstances (see definition above)?

______ Estimated Number  Don’t Know

12. Approximately how many youth (ages 5-17) were tutored through your Learn and Serve America supported service-learning activities?

_____ Estimated Number  Don’t Know  Do not have tutoring activities (skip to question 13)

12a. Approximately how many of those tutored are from disadvantaged circumstances (see definition above)?

______ Estimated Number  Don’t Know

IV. Program Duration and Service-Learning Characteristics

13. This question is designed to gather information on the duration of Learn and Serve America service-learning activities and the amount of time service-learners are engaged in preparation, reflection, and service. Please fill in the table below with the numbers of service-learners 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 service-learners 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-learners who were in service-learning programs of the durations listed in the table below from October 1, 2010 to June 30, 2011. If you have more than one activity or program in a given duration, please combine them in reporting participant numbers and hours. The total number of participants reported for this question may not equal the total number of participants reported in question 7 if individuals participated in more than one service-learning activity.

2. Next, for each of the project durations, calculate the average hours of preparation for the service and formal reflection per service-learner during or after the service and enter that figure in column 3.

3. Finally, enter the average number of hours of service for a service-learner. 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 educational 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).

EXAMPLES

Duration	Do Not Run This Type of Program	Number of Service-Learners	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		a. 60 participants	b. 8 hours each	c. 2 hours each
Programs and activities that last for most or all of one semester or term		d. 25 students	e. 63 hours each	f. 10 hours each
Programs and activities that last for most or all of the whole school year

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
Programs and activities that last for most or all of one semester or term
Programs and activities that last for most or all of the whole school year

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

14. Approximately what percentage of service-learning activities supported by the Youth Engagement Zone occurs during the following periods? Note: Percentages should add to 100%.

	Percent	Don’t Know
In-school time		
Extracurricular programs that occur in schools
After-school programs that occur in schools
Out-of-school community-based programs

V. Project Characteristics

15. How frequently do the Learn and Serve America supported service-learning activities in the Youth Engagement Zone include the following characteristics?

	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					

VI. Community Needs and Service Activities

Community Needs

16. This question is designed to gather information on the community needs that the Learn and Serve America supported service-learning activities have been designed to address. The community needs have been categorized into ten general issue areas. 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.

Community Development ____ % of service activities

 Civic/Public Infrastructure	 Homeless Assistance	 Transportation
 Community Clean-up	 Social Services Planning/Delivery	 Volunteer Capacity/Management
 Historic Preservation	 Animal Care Services	 Independent Living Assistance
		 Other Community Development (specify)

Economic Development ____ % of service activities

 Financial Literacy	 Workforce Development	 Financial Asset Development
 Economic Revitalization	 Technology Access	 Other Economic Development (specify)

Disaster Recovery and Relief ____ % of service activities

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

Education ____ % of service activities

 Adult Literacy	 Computer Literacy	 Special Education Programs
 After School Programs	 English Language Learning	 Classroom Education
 Child Literacy	 Job Preparedness	 Cultural Heritage
	 School Preparedness	 Other Education (specify)

Environment and Energy ____ % of service activities

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

Health & Wellness/Nutrition _____ % of service activities

 Disabilities Services	 HIV/AIDS Prevention	 Nutrition Education
 Food Distribution/Collection	 Health & Wellness Education	 Substance Abuse Prevention/Rehabilitation
 Food Production	 Maternal/Child Health Services	 Aid to Seniors/Elders
 Health Service Delivery	 Mental Health Services	 Other Health/Nutrition (specify)

Public Safety ____ % of service activities

 Accident Prevention	 Crisis Intervention	 Victim/Witness Services
 Community Policing	 Fire Prevention	 Public Safety Education
 Conflict Resolution/Mediation	 Legal Assistance	 Crime Awareness/Prevention
 Offender/Ex-Offender Services/Rehabilitation	 Children and Youth Safety	 Other Public Safety (specify)

Youth Development ____ % of service activities

 Children and Youth Safety	 Juvenile Justice Services	 Bullying Prevention
 Delinquency Prevention	 Teen Pregnancy/Parenting Services	 Other Youth Development (specify)
 Gang Prevention/Rehabilitation	 Youth Leadership Development

Veterans Assistance ____ % of service activities

 Housing Assistance	 Military Family Assistance	 Veteran Employment Services
 Outreach and Counseling	 Veteran Disabilities/ Rehabilitation Assistance	 Other Veterans (specify)

Service Activities

17. (For the most common issue area, or the issue area with the highest percentage of activities in question 16) 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: You only need to provide activities for the most common community need. If desired, you may provide a description of service activities for more than one community need.)

VII. Community Partners

The following questions are designed to gather information on the community partners (community agencies, local government, businesses, etc.) that were formally involved in managing, planning, and/or implementing Youth Engagement Zone activities during the 2010-2011 program year.

18. How many community partners were involved in Youth Engagement Zone activities?

_______  Don’t Know

18a. Of the total number of partners, how many served as a service-learning placement site?

_______  Don’t Know

18b. Of the total number of partners, how many are faith based organizations?

______  Don’t Know

18c. Of the total number of partners, how many provide in-kind or cash support for service-learning?

______  Don’t Know

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

 Yes  No  Don’t Know

19a. 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

20. Which of the following Corporation for National and Community Service programs collaborated in implementing the Youth Engagement Zone activities? (Check all that apply)

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

21. Which of the following other federal programs collaborated in implementing the Youth Engagement Zone 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

VIII. Institutional Supports for Service-Learning

22. On average, how long have there been organized service-learning activities in the secondary schools (e.g. regular, ongoing service-learning)?

 One year or less

 Two to five years

 Six years or more

 Don’t Know

23. You indicated previously that [autofill Q1] secondary schools are included in the Youth Engagement Zone. Of those schools, how many have the following policies in place (if none, enter “0”):

	Number of schools	Don’t Know
Service-learning is recognized by the school as an improvement strategy in its strategic plan or improvement plan	____	
Service-learning is part of the board approved course curriculum in at least one subject in at least one grade in the school. *(If yes, answer question 24)	____	
Service-learning is part of the board approved course curriculum in at least one course that is a required for graduation in the school.	____	
Service-learning participants are formally recognized through the President’s Volunteer Service Award	____	

24. * 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.

 Art/Music/Theater	 Math	 Vocational/ Career Education
 Computer Science	 Physical Education	 Advisory Period
 English/ Language Arts	 Science	 Elective
 Foreign Languages	 Social Studies	 Gifted/ Talented
 Health	 Special Education	 Other

25. During the past year, to what extent were the following practices and supports available for Youth Engagement Zone service-learning activities? Please indicate how regularly or widely each type of support was available.

	Never	Rarely	Occasionally	Frequently	Always
Students are involved in decision-making about the service-learning activities, for example, through an advisory council or other formal decision-making body					
Parent and/or family volunteers participate in service learning activities					
Reduction in teaching/work load to allow time for service-learning program development or supervision					
Recognition or rewards for teachers and staff for quality service-learning practice					

IX. Service-Learning Coordinator

26. Is there full or part-time service-learning coordinator(s) or staff person(s) with responsibility for service-learning in the Youth Engagement Zone?

 Yes  No (skip to question 33)

27. If there is a service-learning coordinator in the Youth Engagement Zone, how many years of professional experience has the coordinator had with service-learning (for example, as a coordinator, teacher, etc.)? If there is more than one coordinator, please provide information on the primary coordinator.

 Less than 1 year  1-4 years  5 years or more

28. Is the service-learning coordinator a full time or part-time employee (with the school district, school, community college or community-based organization)?

 Full-time  Part-time

29. Approximately what percentage of the coordinator’s total job responsibilities is devoted to service-learning?

 100 %  75%  50%  25%  Less than 25%

30. Please select the answer that best describes the extent of training and professional development the service-learning coordinator has received.

 No formal education, training, or professional development related to service-learning

 One workshop, conference, or training session

 Multiple workshops, conferences, or 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 or training sessions

31. What percentages of the service-learning coordinator’s salary came from grants and institutional funds in 2010-2011 (including Learn and Serve America funds):

Grants _____% Institutional funds _____%

X. Training and Technical Assistance and Curriculum Development (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 was provided during the 2010-2011 program year that was supported by the Youth Engagement Zone grant.

32. How many teachers, faculty and/or staff participated in training and technical assistance activities that were supported by Learn and Serve America grants funds during the 2010-2011 program year?

_______Number  None  Don’t Know

33. [If respondent reported teachers, faculty and/or staff in 33] 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		

34. How many college students participated in training and technical assistance activities that were supported by Learn and Serve America grant funds during the 2010-2011 program year?

_______ Number  None  Don’t Know

35a. How many of the college students that participated in training and technical assistance activities were pre-service teachers?

_______ Number  None  Don’t Know

35. [If respondent reported college students in 35] 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		

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

OMB Control Number 3045-0089