Form 1 Member Experience Pre-screening questions

Corporation for National and Community Service (CNCS)

Understanding the Value of Service in Participants’ Experience and Outcomes

Pre-Screening Questions

[These questions will be used to identify (i.e., pre-screen) veterans and individuals from disadvantaged circumstances for the survey.]

Overview

The Corporation for National and Community Service (CNCS) engages more than five million Americans as community volunteers (i.e., service participants/members/volunteers) in service through its core programs such as Senior Corps and AmeriCorps. In CNCS’s 2011-2015 strategic plan, the agency commits to strengthening the national service experience. In order to better understand your experience with service/volunteering and what features help to make the service experience meaningful, CNCS has contracted with ICF International to gather specific information from you on your service/volunteer experience.

Your Role

We believe you have insight that would be very valuable to this project and CNCS given your service experience. We would like to request a few minutes of your time to answer some questions about you and your service experience. Once we receive your responses to these brief questions, we may follow up with you to ask if you are willing to participate in a survey. Your time and dedication to our project is greatly appreciated. If you have any additional questions, please feel free to contact Dr. Beth Heinen, project manager at ICF, at (314) 918-0373 or [email protected]. You may also contact Scott Richardson at (202) 606-6903 or [email protected]..

IMPORTANT NOTE:

To better understand circumstances that impact participant experience, we ask some questions of a potentially sensitive nature. Please know that your contact information and other responses will be used by the ICF project team for project purposes only and will not be shared with any other entity. We will maintain strictly confidentiality of the responses you provide so that your name will not be associated with any specific responses. While we appreciate your participation, your participation and responses to any of these questions is voluntary and not required by CNCS.

Questions

1. [Ask all] In order for ICF to contact you, could you please confirm your contact information:

Full Name; Phone; Gender: [F/M/Do not wish to identify]

[Ask of AmeriCorps only] Could you confirm:

Email; Birth Month/Year

[Ask of Senior Corps only] Please provide the following information:

Email; Birth Month/Year

[Ask all] Do you have a preferred means of contact?

2. [Ask AmeriCorps only. This will be used to identify individuals from disadvantaged circumstances.] Please mark YES if any of the following that previously applied or currently apply to you (but do NOT indicate which apply or applied to you):

• Yes

• No

I dropped out of or did not complete high school. I do not have a high school diploma or have not acquired a GED.

I was unemployed. Check this box if you were not in school and considered unemployed for any length of time. Do NOT check this box if you were unemployed while enrolled in school or took normal vacation breaks between years of high school or post-secondary education.

I was in foster care or I lived with a relative through a state-supervised kinship or guardianship program.

I have limited English proficiency because English is not my native language.

I was homeless for any length of time. Check this box if for a period of time you lacked a fixed, regular, adequate night-time residence, or if you lived in a shelter or place not designated as a regular sleeping accommodation.

I left home and remained away without parental or guardian permission for any length of time under the age of 18 years.

I attended a continuation or alternative high school.

I was enrolled in a program for students at risk of dropping out of high school.

I was convicted of an offense as a juvenile or adjudicated as a juvenile offender.

I was (or am) an individual with one or more physical, mental or learning disabilities.

I received free or reduced school meals at any time.

2. Which of the following best describes your military status?

• Currently serving in one of the branches of the U.S. Armed Forces, U.S Joint Forces, military Reserves, or National Guard

• Currently a Veteran due to prior service in one of the branches of the U.S. Armed Forces, U.S Joint Forces, military Reserves, or National Guard

• Never served in one of the branches of the U.S. Armed Forces, U.S Joint Forces, military Reserves, or National Guard