OMB Control No.: 0970-xxxx
Expiration Date: xx/xx/20xx
Appendix D: Site Visit Information and Observational Sheet
Site visitors should complete as much of this sheet prior to the visit based on PIR data and the telephone interview. Information should be confirmed and other sections should be completed while on site. These data should capture descriptive information about the program organization and context which will later support our analyses and reporting. Reading these notes should give us a snapshot of the program and what occurred during the visit.
Program ID#: ___________________________
Program options: Center-based: # of days per week? _____ Full-day or Part-day?
Home-based
Combination option
Family child care
Other, specify:
Number of Head Start children served in center-based: ________ in home-based: ________
Number of EHS children served in center-based: ________ in home-based: ________
If applicable, number of Head Start classrooms: _________ EHS classrooms: ______
Agency Type:
Community Action Agency (CAA)
School System
Charter School
Private/Public Non-Profit (Non-CAA) (e.g., church or non-profit hospital)
Private/Public For-Profit (e.g. for-profit hospitals)
Government Agency (Non-CAA)
Agency Affiliation:
A secular or non-religious agency
A religiously affiliated agency or organization providing essentially secular services
Agency Description:
Grantee that directly operates program(s) and has no delegates
Grantee that directly operates programs and delegates service delivery
Grantee that maintains central office staff only and operates no program(s) directly
Grantee that delegates all of its programs; it operates no programs directly and maintains no central office staff
Delegate agency
Brief description of program location(s) and setting(s) visited:
Brief description of facility and space (age and functionality, layout of space, general quality of indoor and outdoor space and resources):
Were there any disruptions during the visit that affected data collection?
Were all interviews completed? If no, which were not completed and why?
Were all interviews recorded? If no, which were not recorded and why?
How would you describe the level of engagement of each respondent group?
Directors?
Managers/Coordinators?
Teachers/Home Visitors?
Parents?
Governing body?
Policy council?
LEA?
Additional summary notes:
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Heather Sandstrom |
| File Modified | 0000-00-00 |
| File Created | 2021-01-29 |