Form 1 Senior Corps Program Progress Report

Senior Corps Program Progress Report

OMB Control Number 3045-0033 – Expiration Date January 31, 2023

Public reporting burden for this collection of information is estimated to average 16 hours per response, including reviewing instructions, gathering and providing the information needed to complete the form. Send comments regarding this burden or content of this instrument to: Corporation for National and Community Service (CNCS), National Service Trust, 250 E Street SW, Washington, DC 20525. CNCS informs the potential person(s) who are to respond to this collection of information that such persons are not required to respond to the collection of information unless it displays a currently valid OMB control number on this page of the form. (See 5 C.F.R. 1320.5(b)(2)(I)).

Demographics	Value
Vol Data Total Number of Cumulative Hours this budget period
Vol Data Total number of active volunteers serving this budget period
Total number of hours spent in support of work plans that meet National Performance Measures requirements
Total number of volunteers in support of work plans that meet National Performance Measures requirements

Narratives	Value
Challenges
Partnership/collaboration development
Non-federal share development
Other accomplishments
Stories
List of additional documents sent to CNCS
Corrective Action Plan
Evidence-based program progress

Performance Measures
This section auto-populates based on application selections; grantee provides actuals for each work plan	Actual Unduplicated Volunteers	Total Volunteers	Output Actual	Outcome Actual	Grantee Note

Veterans
This section auto-populates based on application selections; grantees provide actuals for each work plan	# who are Veterans	# who are Veteran Family Members	# who are Active duty	# who are Family Members of Active Duty Military Service Members

Age Group of Volunteers	Number of Volunteers
55 to 59
60 to 69
70 to 79
80 to 84
85 and over

Gender of Volunteers	Number of Volunteers
Female
Male

Ethnicity	Number of Volunteers
Hispanic or Latino
Non-Hispanic or Non-Latino
Racial Group	Number of Volunteers
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Island
White

Volunteers	Number of Volunteers
Total number of Senior Corps volunteers
Total number of hours served
Total number of volunteers federally funded
Total number of volunteers non-federally funded
Total number of non-stipend volunteers
Total number of volunteers who serve in private homes
Total number of potential volunteers on waiting list
Total number of RSVP volunteers that mobilize volunteers for other organizations
Total number of non-RSVP volunteers engaged by RSVP volunteers
Total number of veterans serving as RSVP/FGP/SCP volunteers
Total number of military members serving as RSVP volunteers
Total number of RSVP/FGP/SCP volunteers serving family members of active duty military service members

Volunteer Hours Served	Number of Volunteers
4 or fewer hours per week
5-14 hours per week
15-19 hours per week
20-29 hours per week
30-40 hours per week

Volunteer Leaders	Number of Volunteers
Number of Leaders
Number of community volunteers recruited by leaders
Number of Senior Corps volunteers recruited by leaders

Volunteer Separated	Number of Volunteers
Employment, moved, family, new interests
Health problems, death
Transportation problems
Poor performance
Became ineligible to receive stipend due to income

Volunteer Client/Beneficiary Ratio	Number of Volunteers
Serve 1 client weekly
Serve 2 clients weekly
Serve 3-5 clients weekly
Serve 6-10 clients weekly
Serve 11 or more clients weekly

Beneficiaries Served	Number of Beneficiaries
Total number of clients served
Number of potential clients on waiting list
Number of caregivers receiving respite
Total number of veteran beneficiaries served
Total number of military members served
Total number of families of military members served
Total number of families of veterans served
Total number of children mentored
Total number of children tutored
Total number of children positively indirectly impacted by Senior Corps volunteer involvement in CNCS-supported programs (e.g. classroom, summer programs, afterschool programs, etc.)

Ages of Beneficiaries Served	Number of Beneficiaries
Birth to age 5
Ages 6 - 12
Ages 13 - 19
Youth Ages 20 and higher
Ages 22-44
Ages 45-64
Ages 65-74
Ages 75-84
Ages 85 and higher

Special Needs Served	Number of Volunteers	Number of beneficiaries in home	Number of beneficiaries not in home
Abused/Neglected Children
Adjudicated Youth / Juvenile Offenders
Children with HIV/AIDS
Developmental Disabilities
Emotional Disabilities
Hearing Impaired
Homeless
Language Barriers
Learning Disabilities
Other Special Needs
Physical Disabilities
Significantly Medically Impaired
Substance Abuse
Teen Pregnancy/Teen Parenting
Terminally Ill
Visually Impaired

Special Needs Served	Number of Volunteers	Number of beneficiaries
Alzheimer's Disease
Chronic Care Disabilities/Frail Elderly
Developmentally Disabled Adult
Emotionally Impaired Adult
Hearing Impaired Adult
Short-Term Disabilities
Substance Abuse (Adult)
Terminally Ill Adult
Caregivers receiving respite through Senior Corps services
Visually Impaired Adult
Other Special Needs

Stations	Number of Stations/Volunteers
Total number of faith-based stations
Total number of faith-based volunteers
Total number of stations supporting evidence-based programs
Total number of volunteers supporting evidence-based programs
Total number of stations with volunteers supporting STEM programs
Total number of volunteers supporting STEM programs
Total number of stations supporting Legal Aid or Elder Justice initiatives
Total number of volunteers supporting Legal Aid or Elder Justice initiatives
Total number of disaster services stations
Total number of disaster services volunteers