Respondent Information Form- Partner Staff

Attachment 11: Respondent Information Form Frontline and Partner Staff

Linking to Employment Activities Pre-Release (LEAP) Evaluation

Site Visit Protocols

March 2016

This page has been left blank for double-sided copying

OMB No.: xxxx-xxxx

Respondent Information Form

Frontline and Partner Staff Focus Groups

Expiration Date: xx/xx/xxxx

A1. What is the highest level of education you have completed?

Mark one only

1 □ High school diploma or equivalent

2 □ Some college

3 □ Associate’s degree or vocational degree

4 □ Bachelor’s degree

5 □ Master’s degree or higher

A2. How long have you been employed at your current organization?

| | | years and | | | months

A3. How long have you been employed at your current position?

| | | years and | | | months

A4. How many years of experience do you have working with individuals with criminal or delinquent backgrounds?

| | | years

A5. How many years of experience do you have in workforce development?

| | | years

A6. What is your current work status?

Mark one only

1 □ Full-time employee (30 hours per week or more)

2 □ Part-time employee (1 to 29 hours per week)

3 □ Consultant contract

A7. Which of the following represent your primary activities for the LEAP program?

Please only mark services that you provide directly.

Mark All That Apply

1 □ Participant recruitment

2 □ Screening potential participants for eligibility

3 □ Providing case management services, including initial needs assessment

4 □ Providing job readiness training or services

5 □ Providing job search or job retention assistance

6 □ Connecting participants to employment services in the community AJC

7 □ Connecting participants to support services in the community

8 □ Collecting or entering data for program management or reporting

9 □ Supervising LEAP program staff

10 □ Building relationships with employers

11 □ Providing adult education or GED services

12 □ Providing occupational skills training

13 □ Providing mental health or substance abuse services

14 □ Monitoring probation or parole compliance

15 □ Other (specify)

A8. During a typical work week, about what percentage of your time is spent on LEAP activities/services?

| | | | percent of the time

A9. During a typical work week, what is your average LEAP caseload size?

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays an Office of Management and Budget (OMB) control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this collection of information is estimated to average 3 minutes, including the time to review instructions, search existing data resources, gather the data needed and complete and review the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to NAME at xxx-xxx-xxxx or NAME@___.gov and reference the OMB Control Number xxxx-xxxx.

| | | | participants

B. STAFF DEMOGRAPHICS

B1. What is your gender?

Mark one only

1 □ Female

2 □ Male

3 □ Other

B2. What is your age?

1 □ 30 years old or younger

2 □ 31 – 40 years old

3 □ 41 – 50 years old

4 □ 51 – 60 years old

5 □ 61 years old or older

B3. Are you Hispanic or Latino?

1 □ Yes

0 □ No

B4. What is your race?

Mark All That Apply

1 □ American Indian or Alaska Native

2 □ Asian

3 □ Black, African American

4 □ Native Hawaiian or other Pacific Islander

5 □ White

6 □ Other (specify)