Form 2 Partner Survey

_{AmeriCorpsCommunityEngagementSurvey - Partners}

The Corporation for National and Community Service (CNCS) is a federalagencythatprovidesfundingfornationalserviceprogramsincludingAmeriCorps.Weare conducting a survey of AmeriCorps grantees, sub­grantees and communitypartnerstoassesshowourAmeriCorpsgranteesareworkingincommunities.

As indicated in the email invitation, you were identifiedbyanAmeriCorpsServiceSiteinyourcommunitytoparticipateinthissurvey.

We areinterestedinlearninghowAmeriCorpsgrantshavecontributedtothedevelopmentof"communitypartnerships"andbenefitedcommunitiesbeyondthe direct services they provide individuals.

Forthepurposesofthissurvey,“community”isdefinedasthelocalgeographicareatargetedbyAmeriCorpsprogramsandactivities."Partnerships"may include, among other things, shared administrative tasks or functions, joint ventures, support activities on behalf of beneficiaries, and primary services for mutual clients.

YourindividualresponseswillnotbesharedwithCNCSprogramofficeormanagement*.Theywill be used by AFYA, Inc., and the CNCS Office of Research & Evaluation, and allresultswillbesharedonlyintheaggregatesuchthatyouoryourorganization will not be identifiable, and yourresponseswillhavenoimpactonthefuturefundingoftheAmeriCorpsprogramyoupartnerwithoryourorganization.

Use the NEXTbutton at the end of each page to advance to the next page of the survey. Use PREV to go back to theprevious page of questions.

*PRIVACY ACT NOTICE: The Privacy Act of 1974 (5 U.S.C § 552a) requires that the following notice be provided to you: The information requested in the AmeriCorps Community Engagement Survey Form is collected pursuant to 42 U.S.C 12592 and 12615 of the National and Community Service Act of 1990 as amended, and 42 U.S.C. 4953 of the Domestic Volunteer Service Act of 1973 as amended, and 42 U.S.C. 12639. Purposes and Uses - The information requested is collected for the purposes of assessing the degree to which grantees engage the communities they serve, as part of a longer term research agenda to evaluate AmeriCorps’ impact on the communities it serves. CNCS also will collect information from grantee partners, which are integral in engaging and serving client communities. Routine Uses - Routine uses may include disclosure of the information to federal, state, or local agencies pursuant to lawfully authorized requests. The information may also be provided to appropriate federal agencies and Department contractors that have a need to know the information for the purpose of assisting the Department’s efforts to respond to a suspected or confirmed breach of the security or confidentiality or information maintained in this system of records, and the information disclosed is relevant and unnecessary for the assistance. The information will not otherwise be disclosed to entities outside of the Corporation for National and Community Service without prior written permission. Effects of Nondisclosure - The information requested is not mandatory.

_{AmeriCorpsCommunityEngagementSurvey}

_{InteractionswithPartnerOrganization}

The"referringorganization"mentionedinquestionsbelowistheorganizationidentifiedintheemailinvitationyoureceivedforthissurvey.Please keepthisorganizationinmindasyouanswerthequestionsinthissurvey.

1.Doesyourorganizationcurrentlycollaboratewiththereferringorganizationasapartner organizationinyour community?

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_{Yes­toagreatextent}

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_{Yes­toalimitedextent}

mlj^No

_{AmeriCorpsCommunityEngagementSurvey}

_{InteractionswithPartnerOrganization}

^{2.Hasstafffromyourorganizationservedonanycommunityadvisoryboards, steeringcommittees,advocacygroups,}

_{taskforces,orotheradhoccommitteeswiththereferringorganization?}

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_Yes

_mljNo

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_{Don't know}

_{3.AreyouawarethatthereferringorganizationhasAmeriCorpsmembersserving withthem?}

_mlj

_Yes

mlj^No

_{AmeriCorpsCommunityEngagementSurvey}

_{InteractionsWithAmeriCorpsMembers}

_{4.HasthereferringorganizationdescribedthegoalsfortheirAmeriCorpsmemberstoyou?}

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_Yes

_mljNo

_{5.Isyourcollaborationwiththereferringorganizationaresult,inwholeorpart,oftheAmeriCorpsmemberstheyhave?}

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_Yes

_mljNo

mlj

Don't know

_{AmeriCorpsCommunityEngagementSurvey}

_{InteractionswithPartnerOrganization}

_{6.Inwhatwaysdostafffromthereferringorganizationinteractwithyourorganization?(Selectalltheapply)}

_fec

_{Wecollaboratetoassesscommunityneeds}

_fec

_{Theyparticipateinourshortandlongrangeplanning}

_fec

_{Wecoordinateourprograms’ services}

_fec

_{Weprovideexistingservicestogether}

_fec

_{They helpusdevelopandimplementnewservices}

_fec

_{Weservetogether inprofessionalassociations,adhoccommitteesorworkgroups}

_fec

_{Weworktogetherinfundraising, programpromotion,orpublicrelationscampaigns}

_fec

_{Wesharetechnicalskillsorresourcesandperformessentialtasks}

_fec

_{Weorganizecommunity projects(e.g.community gardens,blockwatchesetc.)}

_fec

_{Membersprovideservicestoourbeneficiaries}

_fec

_{WeprovideresourcestohelptheAmeriCorpsprogramdeliverservices}

Other(pleasespecify)

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AmeriCorpsCommunityEngagementSurvey

7.Thecommunityyouworkinmayfacevariouschallengesinitscapacitytoaddresscommunity­wideproblems(e.g. health,educational,safety,economic).

Howmuchisthereferringorganizationaddressingthefollowingchallenges:

Don’tknow Notatall Alittle Amoderateamount Alot ^{Limitedfinancialresources} nmlkj nmlkj nmlkj nmlkj nmlkj ^{Limitedcapacityfordirect services} mlj mlj mlj mlj mlj ^{Limitednumberoforganizationstoaddresstheproblems} nmlkj nmlkj nmlkj nmlkj nmlkj ^{Limitedcommunityawareness} mlj mlj mlj mlj mlj ^{Limitedcommunityinputintodecision­making} nmlkj nmlkj nmlkj nmlkj nmlkj ^{Limitedtrust amongcommunitymembers} mlj mlj mlj mlj mlj ^{Limitedopportunitiesforcommunitymemberstotake action} nmlkj nmlkj nmlkj nmlkj nmlkj ^{Limitedcollaboration amongorganizations} mlj mlj mlj mlj mlj

^{Limitedtechnologicalcapacity} nmlkj nmlkj nmlkj nmlkj nmlkj

_{Limitedtrainingofcommunityleaders mlj mlj mlj mlj mlj}

Other(pleasespecify)

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6

_{AmeriCorpsCommunityEngagementSurvey}

^{8.Inyourview,howmucharestafffromthereferringorganizationdoingthefollowing?}

	Don’tknow	Notatall	Alittle	Amoderateamount	Alot
Providing directservices	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Recruiting,managing,ortrainingvolunteers	mlj	mlj	mlj	mlj	mlj
Developingorstrengtheningpartnershipswith other organizationsinthe community	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Organizingcommunity­wideactivitiesorevents(e.g. healthorculturalfairs, community forums)	mlj	mlj	mlj	mlj	mlj
Increasing involvementofcommunity residentsintheprogramsthe AmeriCorpsmembersrun	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Identifyingandraisingawarenessofcommunityissuesorconcerns	mlj	mlj	mlj	mlj	mlj
Identifyingstrengthsinthecommunity	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Workingwith communitymembersandother organizationsinthecommunity toidentifyresources–e.g. financial,humancapital,in-kind,legal	mlj	mlj	mlj	mlj	mlj
Connectingcommunity memberstoresourcesprovidedbyother organizations	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Raisingtheprofileorimportanceofcommunityneeds	mlj	mlj	mlj	mlj	mlj

_{AmeriCorpsCommunityEngagementSurvey}

^{9.InwhatwaysdoAmeriCorpsmembersfromthereferringorganizationinteractwithyourorganization?(Selectallthe}

_apply)

_fec

_{Wecollaboratetoassesscommunityneeds}

_fec

_{Theyparticipateinourshortandlongrangeplanning}

_fec

_{Wecoordinateourprograms’ services}

_fec

_{Weprovideexistingservicestogether}

_fec

_{They helpusdevelopandimplementnewservices}

_fec

_{Weservetogether inprofessionalassociations,adhoccommitteesorworkgroups}

_fec

_{Weworktogetherinfundraising, programpromotion,orpublicrelationscampaigns}

_fec

_{Wesharetechnicalskillsorresourcesandperformessentialtasks}

_fec

_{Weorganizecommunity projects(e.g.community gardens,blockwatchesetc.)}

_fec

_{Membersprovideservicestoourbeneficiaries}

_fec

_{WeprovideresourcestohelptheAmeriCorpsprogramdeliverservices}

Other(pleasespecify)

₅

6

AmeriCorpsCommunityEngagementSurvey

10.Thecommunityyouworkinmayfacevariouschallengesinitscapacitytoaddresscommunity­wideproblems(e.g. health,educational,safety,economic).

HowmuchareAmeriCorpsmembersfromthereferringorganizationaddressingthefollowingchallenges:

Don’tknow Notatall Alittle Amoderateamount Alot ^{Limitedfinancialresources} nmlkj nmlkj nmlkj nmlkj nmlkj ^{Limitedcapacityfordirect services} mlj mlj mlj mlj mlj ^{Limitednumberoforganizationstoaddresstheproblems} nmlkj nmlkj nmlkj nmlkj nmlkj ^{Limitedcommunityawareness} mlj mlj mlj mlj mlj ^{Limitedcommunityinputintodecision­making} nmlkj nmlkj nmlkj nmlkj nmlkj ^{Limitedtrust amongcommunitymembers} mlj mlj mlj mlj mlj ^{Limitedopportunitiesforcommunitymemberstotake action} nmlkj nmlkj nmlkj nmlkj nmlkj ^{Limitedcollaboration amongorganizations} mlj mlj mlj mlj mlj

^{Limitedtechnologicalcapacity} nmlkj nmlkj nmlkj nmlkj nmlkj

_{Limitedtrainingofcommunityleaders mlj mlj mlj mlj mlj}

Other(pleasespecify)

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₆

^{11.PleaseprovideanexampleofhowyouseeAmeriCorpsmembersaddressingcommunitychallengestoidentify and}

_{solvecommunityproblems.}

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_{AmeriCorpsCommunityEngagementSurvey}

^{12.Inyourview,howmucharetheAmeriCorpsmembersfromthereferringorganizationdoingthefollowing?}

	Don’tknow	Notatall	Alittle	Amoderateamount	Alot
Providing directservices	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Recruiting,managing,ortrainingvolunteers	mlj	mlj	mlj	mlj	mlj
Developingorstrengtheningpartnershipswith other organizationsinthe community	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Organizingcommunity­wideactivitiesorevents(e.g. healthorculturalfairs, community forums)	mlj	mlj	mlj	mlj	mlj
Increasing involvementofcommunity residentsintheprogramsthe AmeriCorpsmembersrun	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Identifyingandraisingawarenessofcommunityissuesorconcerns	mlj	mlj	mlj	mlj	mlj
Identifyingstrengthsinthecommunity	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Workingwith communitymembersandother organizationsinthecommunity toidentifyresources–e.g. financial,humancapital,in­kind,legal	mlj	mlj	mlj	mlj	mlj
Connectingcommunity memberstoresourcesprovidedbyother organizations	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Raisingtheprofileorimportanceofcommunityneeds	mlj	mlj	mlj	mlj	mlj

_{AmeriCorpsCommunityEngagementSurvey}

_{AboutYourOrganization}

_{13.Whattypeoforganizationareyou?}

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_{Private Business}

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_{PrivateNon­Profit Organization}

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_{Faithbased Organization}

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_{PublicAgency/Government Office}

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_{Public orCharterSchool}

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_{CollegeorUniversity}

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_{LocalorRegionalCoalition}

Other(pleasespecify)

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_{AmeriCorpsCommunityEngagementSurvey}

_{AboutYourOrganization}

_{14.Whattypesofservicesdoyouprovide?(Selectallthatapply)}

_fec

_{Education(e.g. tutoring,mentoring,GED,adult education)}

_fec

_{Health(e.g. nutrition,accesstocare, accesstoinsurance,awareness)}

_fec

_{Servicestoveteransand/ormilitaryfamilies}

_fec

_{Environment(e.g. education onenvironmentalissues,landconservation,energyconservation,ecosystem development/maintenance)}

_fec

_{Disaster services(e.g. disastereducation,preparation,mitigation,response)}

_fec

_{Economicopportunity(e.g.housingservices,employment counseling, jobtraining)}

Other(pleasespecify)

_{AmeriCorpsCommunityEngagementSurvey}

_{AboutYourOrganization}

^{15.Consideringyourorganization'sinteraction/collaborationwiththereferringorganization,howmuchchangehas your}

organizationmadetothefollowing?

	Don’tknow	Majordecrease	Minordecrease	Nochange	Minorincrease	Majorincrease
Numberofcommunity membersserved	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Types ofservicesoractivities offered	mlj	mlj	mlj	mlj	mlj	mlj
Organizationalcapacity(e.g.staffskills, financialandotherresources, organizationalstructure)	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Numberorstrengthofpartnershipswith other organizationsinourcommunity	mlj	mlj	mlj	mlj	mlj	mlj
Other programoroperation(specifybelow)	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj	nmlkj
Other(pleasespecify)

_{AmeriCorpsCommunityEngagementSurvey}

_{AboutYourOrganization}

_{16.Inwhatyearwasyourorganizationfounded?}

_Year

_{17.Howmanyfull­timeequivalentemployeesdoyouhave?}

_mlj

_1­5

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_6­10

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_11­15

_mlj

_16­20

mlj

20+