Form 1 Bundling Survey Communications Pilot Test

Attachment 1: Instructions for Programs Conducting the Proctored Survey

Provide members with a quiet, comfortable setting in which to complete the survey. Allow approximately 30 minutes for the entire process, including handing out and introducing the survey, and allowing members time to complete and return the survey.

Provide each member:

• The survey

• A pencil

Hand out the survey forms to members and read the instructions out loud (see “Draft Survey Introduction for Proctored Survey” below). Ask if there are any questions, and respond to the questions (see "Responding to Questions from Members" below).

Once members have completed the survey, gather up the completed forms and place in an envelope. Seal the envelope and mail to:

Donald J. Pratt
JBS International
555 Airport Boulevard
Suite 400
Burlingame, CA 94010

If you have any questions, comments or concerns, please contact Don Pratt at 650-373-4984 or [email protected].

Draft Survey Introduction for Proctored Survey

The Corporation for National and Community Service (CNCS) is asking for your help to better understand the experience of AmeriCorps members like you. We are conducting a short survey and would be grateful for your participation.

Your responses will be kept confidential and will only be reported grouped with everyone else’s responses. This is NOT a test. There are no right or wrong answers to the questions. Please choose the responses that best apply to you. This survey will take approximately 15 minutes to complete.

Responding to Questions from Members

Why am I being asked to do this survey? The AmeriCorps program is seeking to understand the impact of participation in the AmeriCorps program on members. AmeriCorps will use the information to demonstrate the value of national service and to improve the AmeriCorps program.

What does the survey ask? What is the survey about? The survey asks questions about your characteristics and background, including age, gender, race/ethnicity, education and employment history, and involvement with the criminal justice system. The survey also asks about your views towards school, work, and community.

Do I have to do the survey? No, the survey is voluntary, and you are free to opt out with no consequence. You can also choose not to answer some of the questions. However the survey will only take 15 minutes of your time, and your responses will help improve programs and services available to you and others.

How my personal information be protected? All data will be kept confidential and will only be reported grouped with everyone else's responses. It will not be possible for someone reading the report to identify you or your responses.

Attachment 2: Draft Initial Email

Dear [First Name] [Last Name]:

I am contacting you to ask for your help with a survey of the AmeriCorps program. Through the survey, we hope to learn more about the experience of AmeriCorps members. The information you provide will help to improve the AmeriCorps program.

Your responses to this survey will be kept confidential and will only be reported grouped with everyone else’s responses. This is NOT a test. There are no right or wrong answers to the questions, so please choose the responses that best apply to you. This survey will take approximately 15 minutes to complete.

Your participation is completely voluntary. You may choose not to participate, and you can choose not to answer some of the questions. There are no consequences if you choose not to participate.

Please follow this link to take the survey: [LINK]

Please complete the survey by no later than [DATE]. Thank you for your help to improve AmeriCorps and support AmeriCorps members.

If you have questions about this project, please contact Adrienne DiTommaso at [email protected] or 202-606-3611. If you have questions about how to complete the survey, please contact Antonio Da Silva at 800-207-0750.

Thank you.

Sincerely,

Antonio Da Silva

Survey Manager

JBS International, Inc.

800-207-0750

If you wish to opt out of the survey, please follow the link below.

https://www.surveymonkey.com/optout.aspx

Attachment 3: Draft Follow-up Email

Dear [First Name] [Last Name],

This is a friendly reminder that we are conducting a survey for the AmeriCorps program. Your prompt response to the survey would be greatly appreciated. Just a few moments of your time would provide us with valuable information. Your input will help us improve the AmeriCorps program.

To access the survey, please use the following link: [LINK]

Please complete the survey no later than [DATE]. We sincerely thank you for your time.

If you have questions about this project, please contact Adrienne DiTommaso at [email protected] or 202-606-3611. If you have questions about how to complete the survey, please contact Antonio Da Silva at 800-207-0750.

Sincerely,

Antonio Da Silva

Survey Manager

JBS International, Inc.

800-207-0750

If you wish to opt out of the survey, please follow the link below.

https://www.surveymonkey.com/optout.aspx

Attachment 4: Draft Phone Survey Script

Instructions to Phone Survey Staff: Dial the telephone number provided in the “Phone” field for the Client and when someone answers, introduce yourself. Be sure to provide your full name and address the respondent by their first name (for example, “Jennifer”).

Here is an example of an introduction:

“(Hello/good morning/good afternoon), is this (client name)?

(Hello/good morning/good afternoon), my name is (your name) and I am calling on behalf of AmeriCorps, we have a survey that we wanted to go over with you quickly, to learn about your AmeriCorps service experience, is this a good time?

If yes,

This survey is confidential. Your responses will only be reported summarized with other responses. This is NOT a test. There are no right or wrong answers to the questions. Remember that the survey is voluntary, in case there is any question you do not want to answer. This survey will take approximately 15 minutes.

Would you be willing to take the survey?”

• IF “NO,” thank the person for their time and end the call. Then enter, “Contact Date,” “Status,” and if possible, note the reason for refusal under “Notes.”

• IF “YES,” say:

“Do you have time to answer the questions now?”

• IF “YES,” conduct the survey.

• IF “NO,” ask the person if there is a better time to do the survey.

• IF “YES,” update “Status” field and record a summary of the conversation and the date for the rescheduled interview in the “Notes”

• IF “NO” or if they will not be available by phone within the timeframe of the survey, ask the person if they would prefer to receive the survey by email or by postal mail. Record a summary of the conversation and the preferred delivery method for the survey in the “Notes” and then immediately send the survey to the person by their preferred delivery method.

Attachment 5: Phone Survey

In order to confidentially track your survey, we will first ask you some questions that will we will use to create a unique code:

What are the first three letters of the city or town in which you were born: _ _ _ [For example: S P R for Springfield]

How many letters are in your last name: _ _ [For example 0 5 for Smith]

What are the first 2 letters of your mother’s first name: _ _ [For example M A for Mary. If unknown, enter “AA”):]

Now I would like to ask you some questions about yourself.

1. What is your date of birth [Month/day/year]

2. What is your gender?

• Male

• Female

• Other (specify): ____

3a. Are you a parent or primary caregiver of a child?

• No

• Yes, and all of my children live with me

• Yes, and some of my children live with me

• Yes, and none of my children live with me

3b. Are you a primary caregiver of a parent or other adult? [No, Yes]

4. Have you served on active duty in the military? [No, Yes]

5. How do you identify yourself in terms of ethnicity/race? Please select all that apply.

• Black, not of Hispanic origin

• American Indian or Alaskan Native

• Asian or Pacific Islander

• White, not of Hispanic origin

• Hispanic

• Other (specify): [open-ended text box]

6. Where do you currently live?

1. City or town _______

2. Zip code ______

Now I would like to ask you a few questions about school and work.

7. What is the highest level of education that you have completed?

• Some high school

• High school diploma or GED

• Technical school / Apprenticeship

• Some college

• Associate’s degree

• Bachelor’s degree

• Graduate degree

• Other (please specify): __________

[If applicable] When did you receive a high school diploma or GED? What month and year?

8. When were you last enrolled in school – What was the month and year?

9. What school did you most recently attend?

• High school

• Vocational/technical/alternative school

• Community college

• 4-year college

10. Are you currently employed (If interviewing an AmeriCorps Member: other than your service with AmeriCorps)? [No; Yes]

10a. [If Yes] Please describe your current employment status:

• Part-time 1-20 hours per week

• Part time 21-39 hours per week

• Full-time 40 or more hours per week

10b. [If Yes] How long have you held your current position?

• Less than 1 month

• 1 to 3 months

• 4 to 6 months

• More than 6 months

10c. [If No] Please describe your current employment status:

• Looking for work

• Not looking for work

• Disabled, not able to work

• Pursuing school or training instead of work

• Engaged in part-time volunteer position, internship, or apprenticeship

• Engaged in full-time volunteer position, internship, or apprenticeship

10d. [If No] Please assess if the follow factors are barriers to employment for you personally [Large barrier to employment, a barrier but can be overcome, not a barrier to employment]:

1. No jobs available where I live

2. Do not have enough work experience for the job I want

3. Do not have enough education for the job I want

4. Have family or other responsibilities which interfere

5. Do not have transportation

6. Not good at interviews or do not know how to create a resume

7. Can make more money not in an “official” job

8. Criminal record makes it difficult to find a job

9. Credit issues make it hard to find a job

10. Illness or injury makes it challenging to find a job

11. Do not wish to work

11. How much money did YOU personally earn in [201x]? __________

12. Have you ever done any of the following?

• A paid part-time job

• A paid full-time job

• A paid internship

• An unpaid internship

• Volunteer work that was not part of a requirement for high school graduation

• Received a stipend for attending a program (note: does not include AmeriCorps)

• Baby-sitting, yard-work or chores that you were paid for by a friend or neighbor

Now I would like to ask you some questions about solving problems and doing work in the community.

13. How much do you agree or disagree that each of the following statements describes you? [Strongly Agree; Agree; Neither Agree nor Disagree; Disagree; Strongly Disagree].

1. I can always manage to solve difficult problems if I try hard enough.

2. If someone opposes me, I can find the means and ways to get what I want.

3. It is easy for me to stick to my aims and accomplish my goals.

4. I am confident that I could deal efficiently with unexpected events.

5. Thanks to my resourcefulness, I know how to handle unforeseen situations.

6. I can solve most problems if I invest the necessary effort.

7. I can remain calm when facing difficulties because I can rely on my coping abilities.

8. When I am confronted with a problem, I can usually find several solutions.

9. If I am in trouble, I can usually think of a solution.

10. I can usually handle whatever comes my way.

14. If you found out about a problem in your community that you wanted to do something about, how well do you think you would be able to do each of the following: [I definitely could do this; I probably could do this; Not sure; I could not do this; I definitely could not do this]

1. Create a plan to address the problem

2. Get other people to care about the problem

3. Organize and run a meeting

4. Express your views in front of a group of people

5. Identify individuals or groups who could help you with the problem

6. Express your views on the Internet or through social media

7. Call someone on the phone you had never met before to get their help with the problem

8. Contact an elected official about the problem

15. How much confidence do you have that you could: [No confidence at all; Very little confidence; moderate confidence; Much confidence; Complete confidence]

1. Use the internet to find information about occupations that interest you

2. Select one occupation from a list of potential occupations you are considering

3. Determine what your ideal job would be

4. Prepare a good resume

5. Decide what you value most in an occupation

6. Find out about the average yearly earnings of people in an occupation

7. Identify employers, firms, and institutions relevant to your career possibilities

8. Successfully manage the job interview process

9. Identify some reasonable career alternatives if you are unable to get your first choice

10. Determine the steps to take if you are having academic trouble

11. Complete a college or trade school application

12. Apply for financial aid to further your educational goals

13. Obtain formal training needed to support your career goals

14. Pass a college course

15. Obtain technical or vocational certification

16. Sign up for health care

17. Obtain housing vouchers or other housing assistance

18. Find community resources that address your needs

16. How much do you agree or disagree with the following: [Strongly Agree; Agree; Neither Agree nor Disagree; Disagree; Strongly Disagree].

1. I have a strong and personal attachment to a particular community

2. I am aware of the important needs in the community

3. I feel a personal obligation to contribute in some way to the community

4. I am or plan to become actively involved in issues that positively affect the community

5. I believe that voting in elections is a very important obligation that a citizen owes to the country

17. Generally speaking, would you say that you can trust all the people, most of the people, some of the people, or none of the people in your neighborhood?

1. All of the people,

2. Most of the people

3. Some of the people

4. None of the people

Now I would like to ask a few questions about your education and career goals.

18. Please indicate how much you agree or disagree with the following statements. [Strongly Agree; Agree; Neither Agree nor Disagree; Disagree; Strongly Disagree].

1. I have a clear idea of what my career goals are

2. I have a plan for my career

3. I intend to pursue education beyond high school (e.g. college, trade school)

4. I know what to seek and what to avoid in developing my career path

19. In the last 6 months, have you done any of the following?

1. Sent in a resume or completed a job application

2. Written or revised your resume

3. Interviewed for a job

4. Contacted a potential employer

5. Talked with a person employed a field you are interested in

6. Taken a GED test

7. Completed a course in high school, college, or an alternative school

8. Completed a college or trade school application

9. Completed a FAFSA application

10. Enrolled in a college, trade school, or a certification course

20. In the last 6 months, have you looked for any of the following?

1. Full-time work

2. Part-time work

3. Internship or apprenticeship

4. Volunteer position

21. Are you currently using or visiting any of the following?

1. Local employment development division

2. Housing center

3. Job center

4. Domestic violence center

5. Food bank

6. Community health clinic

7. Adult school / community college extension programs

8. Mutual support or other assistance programs (e.g. AA, NA, AlAnon, grief support groups)

22. Are you currently accessing any of the following federal or state government supports?

1. Food assistance (e.g. WIC, SNAP)

2. Health care assistance (e.g. Medicaid)

3. Housing assistance (e.g. housing vouchers)

4. Other financial or practical assistance (e.g. TANF, child care assistance programs)

I have a few last questions about voting in elections and involvement with the justice system.

23. Have you ever been convicted as an adult, or adjudicated as a juvenile offender, of any offense by either a civilian or military court, other than minor traffic violations? [No, Yes]

24. Are you currently facing charges for any offense or on probation or parole? [No, Yes]

25. Are you limited in any way in any activities because of physical, mental, or emotional problems? [No, Yes]

26. Were you registered to vote in the last presidential election?

1. Yes

2. No

3. No I was not eligible to vote

4. Don’t know

27. Did you vote in the last presidential election?

1. Yes

2. No

3. No I was not eligible to vote

4. Don’t know

28. In the last 12 months, how often did you participate in the following activities? [Basically every day, a few times a week, a few times a month, once a month, less than once a month, not at all]

1. Participate in community organizations (school, religious, issue-based, recreational)

2. Keep informed about news and public issues

3. Help to keep the community safe and clean

4. Volunteer for a cause or issue that I care about

5. Donate money or goods to a cause or issue that I care about

29. What programs are you participating in or services are you receiving?

1. AmeriCorps or similar national or community service program

2. Employment supports (e.g., job training)

3. Educational supports (e.g., tutoring, GED classes, college enrollment assistance)

I appreciate your taking the time to talk today! Thank for helping with our survey.

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