Attachment A: Instruments

Attachment A: Instruments
Contents
Instrument 1. Review Panelist Survey ....................................................................................................... 1
Instrument 2. Grantee Baseline Survey .................................................................................................... 0
Instrument 3. Annual Progress Report ...................................................................................................... 0
Instrument 4. Grantee Learning Opportuni�es Quarterly Survey ............................................................ 2
Instrument 5. Learning Opportuni�es Tracker .......................................................................................... 7
Instrument 6. Learning Logs.................................................................................................................... 11
Instrument 7. Final Descrip�ve Report ..................................................................................................... 0

Instrument 1. Review Panelist Survey
The Na�onal Endowment for the Arts (NEA) is conduc�ng an evalua�on of ArtsHERE to beter
understand the project ac�vi�es supported through this program and how grantees approached the
work. The evalua�on will result in a summary of lessons learned that will be shared with other arts
funders, organiza�ons, and cultural prac��oners seeking to do similar work. Addi�onally, the evalua�on
will inform the implementa�on of the ArtsHERE program.
The purpose of this voluntary survey is to hear from you about your perspec�ves, understanding, and
experience with the ArtsHERE panel review process. The informa�on and feedback you provide will
generate informa�on and learning that can be used by ArtsHERE funders (Regional Arts Organiza�ons
and the NEA) to assess progress toward the program’s goals and inform the replica�on and scale-up of
effec�ve ArtsHERE prac�ces and components.
These data will be made available to the program Evaluator and will not be shared with the NEA, South
Arts, and RAOs except as described below. Informa�on collected for evalua�on purposes, including
individual informa�on deemed sensi�ve in nature, is considered confiden�al and will remain anonymous
and private to the extent permited by law. When results of the ArtsHERE evalua�on are shared with the
public via reports, presenta�ons, and other materials, these results will only be shared in aggregate form
(percentages, means, summaries) to protect the iden�ty of par�cipants. Any subject-iden�fiable
informa�on (including names, contact informa�on, etc.) will not be released without a par�cipant’s
explicit permission. The Evaluator may ask to iden�fy a par�cipant to atribute direct quotes or case
studies to it in reports, presenta�ons, or other materials, and the par�cipant may choose to remain
anonymous.
Your responses in this survey will not impact your current or future awards from the NEA or its partners.
You will not receive any compensa�on for responding to the survey. You may decline to answer any
ques�on you wish. Under the Paperwork Reduc�on Act of 1995, no persons are required to respond to a
collec�on of informa�on unless such collec�on displays a valid Office of Management and Budget (OMB)
control number. The OMB control number for this survey is OMB No. 3135-XXXX, which expires
XX/XX/XXX.
We realize how limited your �me is; the survey should take an average of 20 minutes to complete.
If you have any ques�ons, please contact Dr. Patricia Moore Shaffer, lead for the evalua�on, at
shaff[email protected].
Instruc�ons: Please complete the following informa�on about your experience as an ArtsHERE panel
reviewer.

Demographics/Panelist Backgrounds
1. Did you par�cipate as a volunteer screener conduc�ng independent review of Part 1 applica�ons
for ArtsHERE (i.e. Statement of Interest)?
☐ Yes
☐ No

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2. For which Regional Arts Organiza�on did you serve as an ArtsHERE peer panel reviewer? Please
select from the drop-down list.
☐ Arts Midwest
☐ Mid-America Arts Alliance
☐ Mid Atlan�c Arts
☐ New England Founda�on for the Arts
☐ South Arts
☐ Western States Arts Federa�on
3. Have you or an organiza�on you represent been awarded a grant from an ArtsHERE funder
(Regional Arts Organiza�ons and/or the Na�onal Endowment for the Arts) in the past 5 to 10
years?
☐ Yes
☐ No
4. What sector(s) do you most closely associate your background and experience with? Please select
all that are relevant.
☐ Arts and cultural sector
☐ Child development
☐ Child welfare system
☐ Community center or mul�-use nonresiden�al facility where people meet for social, educa�onal,
and/or recrea�onal ac�vi�es.
☐ Educa�on  
☐ Economic/business development
☐ Faith-based organiza�ons
☐ Family services  
☐ Health 
☐ Housing  
☐ Military support
☐ Rehabilita�on, treatment, and recovery services/programs (substance abuse)
☐ Re-entry programs/Jus�ce (juvenile, adult)
☐ Senior services  
☐ Youth services  
☐ Other (please describe): 
a. Please select the category that best describes your affilia�on: Please select all that are
relevant.
☐ Government
☐ Non-profit with 501(c)(3) status
☐ Federally recognized tribe
☐ Non-federally recognized tribe with 501(c)(3)
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☐ For-profit organiza�on
☐ Self-employed
☐ Other, please specify: (open comment box)
5. Is this your first �me serving on a review panel for a program of any ArtsHERE funders (Regional
Arts Organiza�ons and/or the Na�onal Endowment for the Arts)?
☐ Yes
☐ No

a. If no, please es�mate of the number of ArtsHERE funder review panels you have served on
in the past:
☐ 1-3 other panels
☐ 4 or more
b. [if relevant] To what extent, if any, has your experience on the ArtsHERE review panel
differed from your prior experience(s)?

Perspec�ves on the ArtsHERE Panel Review Process
6. Panelist Orienta�on Process. Please provide your perspec�ves on the panel review process.
Indicate your level of agreement with the following statements.
Statement:

Strongly Agree
agree

Neither Agree Disagree Strongly
nor Disagree 
disagree

The orienta�on clearly communicated
panel expecta�ons.
I was adequately oriented to the goals of
ArtsHERE.
The panelist training handbook provided
helpful informa�on on the review process
and was easy to use.
The GO Smart Grants Management System
training prepared me to effec�vely use the
pla�orm to access the necessary
documenta�on for my reviews.
My ques�ons about ArtsHERE and the
panel process were adequately addressed.
A�er the orienta�on, I felt confident in my
understanding of how to apply criteria to
applica�ons.
A�er the orienta�on I had a clear
understanding of the scoring rubric.
6a. Please provide any addi�onal feedback you have on the orienta�on provided to you.
7. Sa�sfac�on. Please rate your level of sa�sfac�on with the following indicators of your experience
as a panelist.

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Indicator:

Very
sa�sfied

Sa�sfied

Neutral

Unsa�sfied Very
Unsa�sfied

Pacing and flow of panel review process
Number of applica�ons you were assigned
to review
Robustness and relevance of material
received to review and score applica�ons
Quality of ArtsHERE applica�ons
S�pend amount relevant to �me and effort
needed to complete reviews
Quality of reviews by other panelists
RAO facilita�on of the panel discussions
Overall level of reviewer par�cipa�on in
the panel discussions
Extent to which my perspec�ves were
valued
Processes for addressing differences in
opinions among panelists
Level of consensus among panelists
Fairness of final panel ra�ngs
Overall review process
[if respondent indicated neutral to very unsa�sfied in the table above, they will receive the following
prompt(s)]: Please briefly expand on your ra�ng of [statement].
Overall Reflec�ons (narra�ve responses)
8. What worked well with the panel review process?
9. Please provide sugges�ons for improving the panel review process.
Addi�onal Feedback
10. Is there anything else you would like to share about your experience as a panelist for ArtsHERE?

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Instrument 2. Grantee Baseline Survey
The National Endowment for the Arts (NEA) is conducting an evaluation of ArtsHERE. The evaluation
aims to understand the project activities supported through this program and how grantees approach
the work. As part of the evaluation, this survey is being administered to all ArtsHERE grantees upon
acceptance of a grant award.
As an ArtsHERE grantee organization, your participation in this survey is required. This survey expands
on information collected during the application process about ArtsHERE awarded organizations’
characteristics and capacities, community(ies) needs and priorities, and program and community
demographics prior to implementation of an ArtsHERE capacity-building project. Your responses will
inform the development of learning and information services tailored to meet the specific needs and
interests of ArtsHERE-awarded organizations, particularly those historically underfunded cultural
organizations.
These data will be made available to the program evaluator and will not be shared with the NEA, South
Arts, and RAOs except as described below. Informa�on collected for evalua�on purposes, including
individual informa�on deemed sensi�ve in nature, is considered confiden�al and will remain anonymous
and private to the extent permited by law. When results of the ArtsHERE evalua�on are shared with the
public via reports, presenta�ons, and other materials, these results will only be shared in aggregate form
(percentages, means, summaries) to protect the iden�ty of par�cipants. Any subject-iden�fiable
informa�on (including names, contact informa�on, etc.) will not be released without a par�cipant’s
explicit permission. The Evaluator may ask to iden�fy a par�cipant to atribute direct quotes or case
studies to it in reports, presenta�ons, or other materials, and the par�cipant may choose to remain
anonymous.
Repor�ng on grant ac�vi�es, including annual progress and final reports, and comple�ng forms or
surveys intended to collect informa�on or feedback that can inform ArtsHERE services will be required of
all grantees. Your responses in this survey will not impact your current or future awards from the NEA or
its partners. You will not receive any compensa�on for responding to the survey. You may decline to
answer any ques�on you wish. Under the Paperwork Reduc�on Act of 1995, no persons are required to
respond to a collec�on of informa�on unless such collec�on displays a valid Office of Management and
Budget (OMB) control number. The OMB control number for this survey is OMB No. 3135-XXXX, which
expires XX/XX/XXX.
We realize how limited your time is; the survey should take an average of 30 minutes to complete.
If you have any questions, please contact Dr. Patricia Moore Shaffer, lead for the evaluation, at
[email protected].
Instructions: Please complete the following questions about your organization. Your organization will
submit one survey, but responses should reflect input from the core group of individuals involved in
planning and implementing your ArtsHERE capacity-building project.

Your Organization and Environment
1. Grant award number [open text box]
2. What are the primary "sectors" of focus for your organiza�on? (check all that apply)
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☐ Arts and cultural sector
☐ Child development
☐ Child welfare system
☐ Community center or mul�-use nonresiden�al facility where people meet for social,
educa�onal, and/or recrea�onal ac�vi�es
☐ Educa�on
☐ Economic/business development
☐ Faith-based organiza�ons
☐ Family services
☐ Health
☐ Housing
☐ Military support
☐ Rehabilita�on, treatment, and recovery services/programs (substance abuse)
☐ Re-entry programs/Jus�ce (juvenile, adult)
☐ Senior services
☐ Youth services
☐ Other (please describe):
3. What is the primary ar�s�c discipline(s) of your program (i.e. your standard programming)?
(check all that apply)
☐ Ar�st Communi�es (residencies that provide dedicated space, �me, and resources to
ar�sts for the crea�on or development of new work)
☐ Arts Educa�on
☐ Dance
☐ Design
☐ Folk & Tradi�onal Arts
☐ Literary Arts
☐ Local Arts Agencies
☐ Media Arts
☐ Museums
☐ Music
☐ Musical Theater
☐ Opera
☐ Presen�ng & Mul�disciplinary Works (presen�ng works from across disciplines,
mul�disciplinary works, and/or interdisciplinary ar�sts)
☐ Theater
☐ Visual Arts
☐ Other (please describe): _______________________
4. What are your organiza�on’s primary service delivery models for arts and cultural
programming? (check all that apply)
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☐ Ongoing class/other ongoing engagement (e.g., meets regularly for a dis�nct period)
☐ Ongoing drop-in program (e.g., an open studio where par�cipa�on may vary)
☐ Single event (e.g., workshop or exhibi�on individuals par�cipate in one �me)
☐ Par�cipant exhibi�ons or performances of their work
☐ Par�cipants atend performances or exhibi�ons as viewers
☐ Other (please describe):
5. What is your organiza�on’s primary method for offering arts and cultural programming?
(Select one)
☐ In-person only. Refers to arts experiences that occur 100% in-person and do NOT have an
online component.
☐ Virtual only. Refers to arts experiences that occur 100% online.
☐ Both in-person and virtual (i.e., hybrid). Refers to arts experiences that have both virtual
and in-person components.
6. Has the number of staff, volunteers, and board members that are part of your organiza�on
changed since the submission of your full ArtsHERE applica�on? (Select one)
☐ Yes
☐ No
[Skip Logic: Only show if YES to Q5]
5a. What staffing changes has/is your organiza�on facing? (please select all that apply)
☐ Loss of execu�ve director and/or founder
☐ New execu�ve director or interim director hired
☐ Loss of board chair
☐ New board chair
☐ Significant board turnover (50% or more)
☐ Significant staff turnover (50% or more)
☐ Significant volunteer turnover (50% or more)
☐ Other (please describe)
5b. Please let us know how many staff, volunteers, and board members are a part of your
organiza�on at this �me. (Provide a count of number of individuals for each category specified
below)
•
•
•
•
•

# full-�me staff
# part-�me staff
# full-�me volunteers
# part-�me volunteers
# board members

7. Please use this comment box to clarify or describe any staffing, volunteer, and/or board
structure trends that may need addi�onal explana�on. (Example: how many people hold

2

mul�ple posi�ons such as staff/volunteer, volunteer/board member, etc.?) (Open Comment
Box)
8. What aspects of your organiza�on’s current staffing and/or board structure work well?
Consider in your response: (Open Comment Box)
a. What has helped your staffing and/or board structure to be successful in these areas?
b. How, if at all, do you envision ArtsHERE will support your staffing and board structure to
be successful?
8. What, if any, aspects of your organiza�on’s current staffing and/or board structure are not
working as well as you would like? Consider in your response: (Open Comment Box)
a. What organiza�onal capaci�es, resources, and/or tools might be needed to support
staffing and board structures at your organiza�on?
9. Which types of financial support does your organiza�on receive? (Check all that apply)
☐ Federal
☐ State
☐ Local
☐ Corporate dona�ons or sponsorships
☐ Other [please specify]
10. What financial or fundraising support needs have you iden�fied, if any? (Open Comment Box)
a. What have been some of your fundraising strengths?
11. What accomplishments or milestones would your organiza�on like to achieve with its capacity
building project? Consider in your response: (Open Comment Box)
a. Ideally, where do you hope to be as an organiza�on relevant to staffing, board, budget,
opera�ons, or other capaci�es?
12. What, if any, barriers or challenges to building organiza�onal capacity has your organiza�on
experienced in the past, and/or might it an�cipate during the period of performance for
ArtsHERE? Consider in your response: (Open Comment Box)
a. How, if at all, do you envision your par�cipa�on in ArtsHERE informing strategies,
capaci�es, and/or resources to address these barriers and challenges?
About Your Community
13. How would you describe the par�cipa�on trends of your organiza�on’s arts and cultural
programs and services among underserved groups/communi�es in the most recent fiscal year?
Please respond based on your organiza�on's fiscal year. (please select one)
(The term “underserved” refers to those whose opportunities to experience the arts are
limited relative to: geography, race/ethnicity, economics, or disability.)
☐ Our par�cipa�on numbers among underserved groups/communi�es are growing
☐ Our par�cipa�on numbers among underserved groups/communi�es are stable
☐ We’re seeing a mix (some events are up and some are down)
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☐ We’re seeing a decline in par�cipa�on among underserved groups/communi�es.
☐ Don’t know
14. What are your community’s needs that your organiza�on has worked to address? Consider in
your response: (Open Comment Box)
a. How were these needs iden�fied?
15. What strategies, prac�ces, and/or programs are working well to engage underserved
communi�es? Consider in your response: (Open comment box)
a. What supports the success of these strategies, prac�ces, and/or programs (i.e.,
organiza�onal strengths, resources, tools and/or community strengths)?
16. What strategies, prac�ces, and/or programs would you like to improve to beter engage
underserved communi�es? (Open comment box)
a. Please consider in your response any challenges your organiza�on has experienced
relevant to sustaining or increasing par�cipa�on in programs by underserved
communi�es.
17. How do you envision your ArtsHERE capacity-building project suppor�ng your organiza�on’s
efforts to meaningfully engage underserved communi�es? (Open comment box)
a. Please consider in your response any types of support you need to sustain and/or
improve your community engagement efforts.

About Your Networks and Partnerships
18. What sectors do your organiza�on’s key partners belong to? (check all that apply)
☐ Arts and cultural sector
☐ Child development
☐ Child welfare system
☐ Community center or mul�-use nonresiden�al center facility where people meet for social,
educa�onal, and/or recrea�onal ac�vi�es.
☐ Educa�on
☐ Economic/business development
☐ Faith-based organiza�ons
☐ Family services
☐ Health
☐ Housing
☐ Military support
☐ Rehabilita�on, treatment, and recovery services/programs (substance abuse)
☐ Re-entry programs/Jus�ce (juvenile, adult…)
☐ Senior services
☐ Youth services
☐ Other (please describe):
4

19. What partnership opportuni�es would further your organiza�on’s capacity to sustain
engagement with underserved communi�es? (Open Comment Box)

5

Instrument 3. Annual Progress Report
OMB No. XXXX-XXXX. Date Approved xxxx. Expires XX/XX/XXX

1. What type of capacity-building project was supported at your organiza�on through ArtsHERE?
This may or may not have changed from your original applica�on. Please select all that apply
from the drop-down menu. (mul�-select checkbox)
☐ Organiza�onal needs assessment and/or equity planning assessments
☐ Strategic planning or logic model development and/or implementa�on
☐ Staff development or leadership training (such as cultural competency training for staff
and/or those who develop and implement programming)
☐ Stakeholder- and/or community-engagement ac�vi�es
☐ Field-based or community research that will help organiza�ons to beter document their
commitment to equity as evidenced by their prac�ces and programming and their
rela�onship within communi�es
☐ Promo�onal and marke�ng ac�vi�es
☐ Transla�on services to allow individuals with Limited English Proficiency (LEP) to
par�cipate in programma�c ac�vi�es
☐ Other capacity-building ac�vi�es [please specify]: ______________________ (500
characters maximum)
2. Please describe the capacity building project ac�vi�es supported by ArtsHERE that your
organiza�on has completed in the past 12 months. (Open comment box) (3,300 characters
maximum)
In your response, please consider the following prompt to inform your reflec�on:
a. How, if at all, did these project ac�vi�es relate to the arts or cultural programs and
services already offered by your organiza�on to underserved groups/communi�es?
3. What, if any, success(es) has your organiza�on had with its capacity-building project in the past
12 months? (Open comment box) (3,300 characters maximum)
4. Describe any challenge(s) that your organiza�on encountered with its capacity-building grant in
the past 12 months. (Open comment box) (3,300 characters maximum)
In your response, please consider the following prompts to inform your reflec�on:
a. How, if at all, did your organiza�on address these challenges?
b. How, if at all, did the challenge(s) influence your organiza�on’s ability to conduct your
capacity-building project as planned?
5. How, if at all, has your organization’s participation in ArtsHERE strengthened and/or sustained
its arts and cultural programs and services in the past 12 months? (Open comment box) (3,300
characters maximum)
In your response, please consider the following prompts to inform your reflec�on:
0

a. Describe who par�cipated in your organiza�on’s arts or cultural programs and services.
What, if any, rela�onship does your capacity-building project have with community
engagement in arts/cultural experiences?
b. How has par�cipa�on in ArtsHERE informed any strategies your organiza�on uses to
increase equitable access to the arts for underserved groups/communi�es?
c. How, if at all, has the par�cipa�on of underserved groups/communi�es in your
organiza�on’s arts and cultural programs and services changed over the past 12 months
as a result of ArtsHERE?
6. How, if at all, have your experiences and learning in ArtsHERE informed your ac�vi�es or
priori�es for the upcoming year? (Open comment box) (3,300 characters maximum)

PAPERWORK REDUCTION ACT STATEMENT
The public repor�ng burden for this collec�on of informa�on is es�mated at an average of two hours per
response. This includes the �me for reviewing instruc�ons, searching exis�ng data sources, gathering
and maintaining the data needed, and comple�ng and reviewing the collec�on of informa�on. We
welcome any sugges�ons that you might have on improving the guidelines and making them as easy to
use as possible. Send comments regarding this burden es�mate or any other aspect of this collec�on of
informa�on, including sugges�ons for reducing this burden, to: [email protected], Aten�on: Repor�ng
Burden. Note: Applicants/awardees are not required to respond to the collec�on of informa�on unless it
displays a currently valid U.S. Office of Management and Budget (OMB) control number. The OMB
control number for this survey is OMB No. 3135-XXXX, which expires XX/XX/XXX.

1

Instrument 4. Grantee Learning Opportuni�es Quarterly Survey
The Na�onal Endowment for the Arts is conduc�ng an evalua�on of ArtsHERE to beter understand the
project ac�vi�es supported through this program and how grantees approached the work. As part of the
evalua�on, this required quarterly survey is an opportunity to learn about your organiza�on’s
experiences with ArtsHERE learning opportuni�es.
The term “learning opportuni�es” refers to any type of topic-based workshop, one-on-one coaching, or
consulta�on with ArtsHERE coaches, and peer cohort convenings provided to increase the knowledge,
skills, connec�ons, and/or capacity of grantee organiza�ons to work toward their project and
organiza�onal goals.
As an ArtsHERE grantee organiza�on, your par�cipa�on in this quarterly survey is required. Your
organiza�on’s feedback will be used to help ArtsHERE funders (Regional Arts Organiza�ons and the NEA)
beter respond to grantees’ needs and improve the ArtsHERE program.
These data will be made available to the program Evaluator and will not be shared with the NEA, South
Arts, and RAOs except as described below. Informa�on collected for evalua�on purposes, including
individual informa�on deemed sensi�ve in nature, is considered confiden�al and will remain anonymous
and private to the extent permited by law. When results of the ArtsHERE evalua�on are shared with the
public via reports, presenta�ons, and other materials, these results will only be shared in aggregate form
(percentages, means, summaries) to protect the iden�ty of par�cipants. Any subject-iden�fiable
informa�on (including names, contact informa�on, etc.) will not be released without a par�cipant’s
explicit permission. The Evaluator may ask to iden�fy a par�cipant to atribute direct quotes or case
studies to it in reports, presenta�ons, or other materials, and the par�cipant may choose to remain
anonymous.
Repor�ng on grant ac�vi�es, including annual progress and final reports, and comple�ng forms or
surveys intended to collect informa�on or feedback that can inform ArtsHERE services will be required of
all grantees. Your responses in this survey will not impact your current or future awards from the NEA or
its partners. You will not receive any compensa�on for responding to the survey. You may decline to
answer any ques�on you wish. Under the Paperwork Reduc�on Act of 1995, no persons are required to
respond to a collec�on of informa�on unless such collec�on displays a valid Office of Management and
Budget (OMB) control number. The OMB control number for this survey is OMB No. 3135-XXXX, which
expires XX/XX/XXX.
We realize how limited your �me is; the survey should take an average of 15 minutes to complete.
If you have any ques�ons, please contact Dr. Patricia Moore Shaffer, lead for the evalua�on, at
shaff[email protected].
Instruc�ons: Please complete the following informa�on about the ArtsHERE learning opportuni�es you
have received in the past 3 months.

Learning Opportunity Par�cipa�on
[Text box to appear at the top of each survey page that reads: “Learning opportunities” include monthly
cohort sessions, one-on-one meetings with your assigned coach, and workshops with topic-based
experts.]
2

1. Grant award number: [Text box]
2. [ONLY IF grantee received learning opportunities in the past three months- evaluation contractor will
provide a pre-filled summary of service types and topics from organizational tracking data. Text to
read: “Please indicate the type(s) and topic(s) of learning opportunity activities you participated in
during the past three months”]
Based on our records in the past three months (between [start date] and [end date], your
organiza�on par�cipated in learning opportuni�es in the following areas: Please confirm whether
you par�cipated in the following learning opportuni�es.
a. [Type/topic of learning opportunity to be pre-filled based on provider data ]
☐ Yes, my organiza�on par�cipated in this ac�vity.

☐ No, my organiza�on did not par�cipate in this ac�vity.
b. [Type/topic of learning opportunity to be pre-filled based on provider data]
☐ Yes, my organiza�on par�cipated in this ac�vity.

☐ No, my organiza�on did not par�cipate in this ac�vity.
c. [Type/topic of learning opportunity to be pre-filled based on provider data]
☐ Yes, my organiza�on par�cipated in this ac�vity.

☐ No, my organiza�on did not par�cipate in this ac�vity.
o

If No, [if none of the above are accurate], Please indicate the type(s) and topic(s) of
learning opportunity ac�vi�es you par�cipated in during the past three months:
☐ Topic based workshop
• If checked, list the topic(s): [open box]
☐ One-on-One with workshop facilitator
• If checked, list the topic(s): [open box]
☐ One-on-one consulta�on with coach
• If checked, list the topic(s): [open box]
☐ Cohort Mee�ng
• If checked, list the topic(s): [open box]
☐ My organiza�on did not par�cipate in any ArtsHERE learning opportuni�es during
the past three months. [Selection of this option will prompt the thank you screen,
and survey participation is complete.]

d. Did your organiza�on par�cipate in any other learning opportuni�es supported through
ArtsHERE not specified?
☐ Yes
o If yes, please specify type and topic of learning opportuni�es received: [open box]
☐ No
o If no, please specify type and topic of learning opportuni�es received: [open box]
3

3. [ONLY IF grantee did NOT receive learning opportunities in the past three months] Based on our
records in the past three months (between [start date] and [end date]), your organiza�on did not
receive learning opportuni�es. Is this accurate?
☐ Yes
o If yes, please provide addi�onal informa�on regarding why your organiza�on did not
receive learning opportuni�es: [open box]
☐ No
o If no, please specify type and topic of learning opportuni�es received: [open box]
[If no is selected, skip to Question 11 and end survey there]

Perspec�ves on Learning Opportunity Ac�vi�es in the Past Three Months
Learning opportunities include monthly cohort sessions, one-on-one meetings with your assigned coach,
and workshops with topic-based experts.
[Q4-Q8 will only be asked if respondent indicated that they received organizational services in Q1-Q3
above] Please provide your perspec�ve on all the learning opportuni�es supported through ArtsHERE
you par�cipated in the past three months by indica�ng your level of agreement with the following
statements.
4. Relevance
Statement:

Strongl
y agree

Agree

Overall, the learning opportuni�es I
received in the past three months
met the needs of my organiza�on
(e.g., applicability of services and/or
topics addressed to my interests,
services align with project’s and/or
community’s context, and overall
usefulness).

Neither
Agree nor
Disagree

Disagree

Strongly
disagree

4.a. Please provide any addi�onal feedback you have on the relevance of learning opportuni�es you
par�cipated in over the past three months. [Open comment box]
5. Engagement
Statement
Overall, the learning opportuni�es I
received in the past three months
were engaging (e.g., services were
interes�ng, par�cipatory, ac�ve role
in planning).

Strongly
agree

Agree

Neither
Agree nor
Disagree

Disagree

Strongly
disagree

4

5.a. Please provide any addi�onal feedback you have about how engaging the learning opportuni�es you
received during the past three months were for you: [Open comment box]
6. Quality/Sa�sfac�on
Statement
Overall, I was sa�sfied with the quality
of the learning opportuni�es (e.g.,
services are �mely, clear, present
informa�on in an effec�ve manner).

Strongl
y agree

Agre
e

Neither Agree
nor Disagree

Disagree

strongly
disagree

6.a. Please provide any addi�onal feedback you have on the quality of learning opportuni�es you
par�cipated in over the past three months: [Open comment box]
7. Responsiveness of Coach/Facilitator
Statement
Please rate how responsive your coach
and/or facilitator(s) were to your needs
over the past three months (e.g.,
coach/facilitator engaged in ac�ve
listening, acknowledged and was
sensi�ve to the project’s needs and
interests; was open to addressing
topics requested by the project; and
was aware of the project’s unique
organiza�onal and/or community
context):
ArtsHERE Coach (as applicable): [prefilled text about which organization
provided coaching will be piped here]
Topic-based workshop facilitator (as
applicable): [pre-filled text about which
organization led the workshop will be
piped here]
Other service provider, specify: [open
text box]

Not
responsi
ve

Somewhat
responsive

Neutral

Responsiv
e

Highly
respons
ive

7.a. Please provide any addi�onal feedback you have on the responsiveness of your learning
opportuni�es coach and/or workshop facilitator(s) over the past three months: [Open comment box]
8. Effec�veness of Learning Opportuni�es by Type
Statement

Extremely
effec�ve

Very
effec�ve

Moderately
effec�ve

Slightly
effec�ve

Not at all
effec�ve

N/A; Did
not use
5

What best describes the
effec�veness of each of the
following (e.g., did services meet
their intended
objec�ves/purpose, producing the
intended result)?
Monthly cohort convening with
your coach
Individual session(s) with your
coach
Topic based workshop with a
facilitator
Op�onal 1:1 with workshop
facilitator
8.a. Please provide any addi�onal feedback you have on the effec�veness of learning opportuni�es you
par�cipated in over the past three months: [Open comment box]

Overall Reflec�ons (Narra�ve)
Learning opportunities include monthly cohort sessions, one-on-one meetings with your assigned coach,
and workshops with topic-based experts.
9. Were there ways the learning opportuni�es in which you par�cipated over the past three months
could be improved?
☐ Yes
o If yes, please describe how the learning opportuni�es could have been improved. [Open
comments box]
☐ No
10. What other types of learning opportuni�es would you find valuable for enhancing your knowledge,
skills, connec�ons, or capacity? [Open comments box]
11. What, if any, addi�onal feedback would you like to share about the learning opportuni�es and
support you received in the past three months? [Open comments box]

6

Instrument 5. Learning Opportuni�es Tracker
The Na�onal Endowment for the Arts (NEA) is conduc�ng an evalua�on of ArtsHERE to beter
understand the project ac�vi�es supported through this program and how grantees approached the
work. As part of the evalua�on, this tracking form will be used to provide informa�on to ArtsHERE
funders (Regional Arts Organiza�ons and the NEA) about the learning opportuni�es and organiza�onal
services provided to ArtsHERE grantees on an ongoing basis. The evaluator will also share a summary of
findings about grantees and providers’ experiences with learning opportuni�es with providers on an
ongoing basis.
This form is required and should be completed within 48 hours of every learning opportunity session
you hold with an ArtsHERE grantee. The term “learning opportuni�es” refers to any type of topic-based
workshop, one-on-one coaching or consulta�ons, and peer cohort convenings provided to increase the
knowledge, skills, connec�ons, and/or capacity of grantee organiza�ons to work toward their own
project and organiza�onal goals.
These data will be made available to the program Evaluator and will not be shared with the NEA, South
Arts, and RAOs except as described below. Informa�on collected for evalua�on purposes, including
individual informa�on deemed sensi�ve in nature, is considered confiden�al and will remain anonymous
and private to the extent permited by law. When results of the ArtsHERE evalua�on are shared with the
public via reports, presenta�ons, and other materials, these results will only be shared in aggregate form
(percentages, means, summaries) to protect the iden�ty of par�cipants. Any subject-iden�fiable
informa�on (including names, contact informa�on, etc.) will not be released without a par�cipant’s
explicit permission. The Evaluator may ask to iden�fy a par�cipant to atribute direct quotes or case
studies to it in reports, presenta�ons, or other materials, and the par�cipant may choose to remain
anonymous.
Your responses in this form will not impact your current or future awards from the NEA or its partners.
You will not receive any compensa�on for responding to the survey. You may decline to answer any
ques�on you wish. Under the Paperwork Reduc�on Act of 1995, no persons are required to respond to a
collec�on of informa�on unless such collec�on displays a valid Office of Management and Budget (OMB)
control number. The OMB control number for this survey is OMB No. 3135-XXXX, which expires
XX/XX/XXX.
We realize how limited your time is; the form should take an average of 10 minutes to complete per
entry.
If you have any ques�ons about comple�ng this form or how the informa�on will be used, please
contact Dr. Patricia Moore Shaffer, lead for the evalua�on, at shaff[email protected].
Instruc�ons: Please complete this form within 48 hours from the ArtsHERE learning opportunity session
you recently provided. Enter a single learning session/interac�on at a �me (one per form).

Provider Informa�on
Summary of Service Provided
1. Type of Learning Opportunity Provided (Select one)
☐ Topic-based expert workshop (quarterly)
7

☐ Workshop facilitator one-on-one mee�ng with grantee (op�onal for grantees, as
provided)
☐ One-on-one coaching or consulta�on (monthly)
☐ Cohort sessions (monthly)
☐ Other, specify: _____________
[Skip logic: Q3 and Q3a will only show for one-on-one coaching/consulta�on and one-on-ones with
workshop facilitator service entries (i.e., selected in Q1).] [Note that MAAA will provide the evaluator
with registra�on and par�cipa�on rates for workshops and convenings.]
2. Date of Service for the learning opportunity provided (please use MM/DD/YYYY format in your
response).
● [Open box]
3. ArtsHERE grantee organiza�ons that par�cipated in this coaching/consulta�on session (Select
one)
☐ List of all grantees [organized by region for ease of naviga�ng]
☐ Other, please specify: ___________
3.a. [Number of par�cipants in this coaching/consulta�on session (please enter whole number in
these fields, or enter “don’t know” if you did not track the number of par�cipants)
●
●
●
●
●

# Board members: [Open box]
# Paid staff: [Open box]
#Volunteer staff: [Open box]
#Other volunteers (non-staff, non-paid): [Open box]
#Others: [Open box]

[end skip logic]
4. How many total hours of direct service were provided on the date of service? (please enter to
the closest 30-minute increment, e.g., 1.5 hours, 2 hours)
● [Open box]
5. Primary mode of communica�on for this learning session (select one)
☐ Conference Call (voice only)
☐ Videoconference call (audio/video)
☐ In-Person mee�ng
☐ Hybrid mee�ng
☐ Other, specify: ________________
6. Primary topic area of learning opportunity offered (select one)
☐ Finance
☐ Fundraising
☐ Governance
8

☐ Community Engagement
☐ Other, Specify_____________
7a. Were any other topic area(s) addressed during the learning opportunity offered (Y/N)
☐ No, move on to Q8
☐ Yes, [follow-up ques�on pops up]
o

What other topics were addressed? (check all that apply)[
☐ Finance
☐ Fundraising
☐ Governance
☐ Community Engagement
☐ Other, Specify_____________

Overall Service Descrip�on
7. Please provide a brief summary of the learning opportunity session provided, including:
• Purpose and/or objec�ves for the session.
What were you trying to achieve?
• What did the session entail (e.g., discussion, materials used, etc.)? (open comment)
Overall Service Reflec�ons
8. How successful was the learning opportunity session? Please rate your level of agreement
with the statement below.
The session I provided was:
☐ Very successful
☐ Successful
☐ Somewhat successful
☐ Not at all successful
9. What factors contributed to the session’s level of success? (open comment)
10. Is there anything you would want to either repeat or do differently for future sessions? (open
comment)
Next Steps (op�onal)
11. In what ways, if any, are you no�cing—as a result of the session—changes in your behavior,
values, ways of thinking, experience of power and rela�onal dynamics, and/or expecta�ons as
you provide learning opportuni�es? (open comment)
12. As a result of this learning opportunity session, what are the next ac�on steps for you, if any?
(open comment)
9

13. As a result of this learning opportunity session, what are the next ac�on steps for grantee
organiza�on par�cipants? (open comment)
Anything else (op�onal)
15. Is there anything else you would like to share about your experience providing this learning
opportunity session? (open comment)

10

Instrument 6. Learning Logs
The Na�onal Endowment for the Arts (NEA) is conduc�ng an evalua�on of ArtsHERE to beter
understand the project ac�vi�es supported through this program. As part of the evalua�on, this
voluntary learning log will provide important feedback about key lessons learned throughout the
implementa�on of ArtsHERE from the perspec�ve of the ArtsHERE planning group (the NEA, South Arts,
Regional Arts Organiza�ons (RAOs), and evalua�on contractors) for the purposes of program
improvement.
Your responses will be shared anonymously on a secure shared workspace accessible to other members
of the ArtsHERE planning group. Informa�on collected in the learning logs is not to be distributed
outside of the planning group. Responses provided through this form will inform follow-up discussions
with the planning group.
These data will be made available to the program Evaluator and will not be shared with the NEA, South
Arts, and RAOs except as described above. Informa�on collected for evalua�on purposes, including
individual informa�on deemed sensi�ve in nature, is considered confiden�al and will remain anonymous
and private to the extent permited by law. Your responses in this log will not impact your current or
future awards from the NEA or its partners. You will not receive any compensa�on for responding to the
log. You may decline to answer any ques�on you wish. Under the Paperwork Reduc�on Act of 1995, no
persons are required to respond to a collec�on of informa�on unless such collec�on displays a valid
Office of Management and Budget (OMB) control number. The OMB control number for this survey is
OMB No. 3135-XXXX, which expires XX/XX/XXX.
Learning logs will be administered at various �me points throughout ArtsHERE implementa�on and will
cover four topics. We realize how limited your �me is; the log should take an average of 30 minutes to
complete.
If you have any ques�ons about comple�ng this form or how the informa�on will be used, please
contact Dr. Patricia Moore Shaffer, NEA lead for the evalua�on, at shaff[email protected].

11

Learning Log Topic 1: ArtsHERE panel/selec�on process
Log Date: May 2024
Instruc�ons: Learning log ques�ons are designed to prompt though�ul reflec�on and capture valuable
insights into your experiences and lessons learned throughout the planning and implementa�on of
ArtsHERE. Please fill out this learning log based on what you recently learned regarding the
panel/selec�on process.
1. What went well regarding the panel/selec�on process?

2. What challenges or obstacles are you experiencing or observing in the implementa�on of
ArtsHERE regarding the panel/selec�on process?

3. What strategies or approaches do you recommend to address any challenges regarding the
panel/selec�on process?

4. What insights are you learning from the panel/selec�on process that could guide future work
for NEA and RAOs?

12

Learning Log Topic 2: ArtsHERE applica�on and award data
Log Date: June 2024
Instruc�ons: Learning log ques�ons are designed to prompt though�ul reflec�on and capture valuable
insights into your experiences and lessons learned throughout the planning and implementa�on of
ArtsHERE. Please fill out this learning log based on what you recently learned regarding the summary of
applica�on and award data.
1. What went well regarding the summary of applica�on and award data?

2. What challenges or obstacles are you experiencing or observing in the implementa�on of
ArtsHERE regarding the summary of applica�on and award data?

3. What strategies or approaches do you recommend to address any challenges faced regarding
the summary of applica�on and award data?

4. What insights are you learning from the summary of applica�on and award data that could
guide future work for NEA and RAOs?

13

Learning Log Topic 3: Grantee Learning Opportuni�es Quarterly Survey Results
Log Date: Every 3 months from January 2025 through January 2026
Instruc�ons: Learning log ques�ons are designed to prompt though�ul reflec�on and capture valuable
insights into your experiences and lessons learned throughout the planning and implementa�on of
ArtsHERE. Please fill out this learning log based on what you learned from the informa�on that has
recently been shared with you regarding recent Grantee Learning Opportuni�es Quarterly Survey results.
The term “learning opportuni�es” refers to any type of topic-based workshop, one-on-one coaching or
consulta�ons, and peer cohort convenings provided to increase the knowledge, skills, connec�ons,
and/or capacity of grantee organiza�ons to work toward their own project and organiza�onal goals.
1. What is going well regarding to learning opportuni�es?

2. What challenges or obstacles are you experiencing or observing in the implementa�on of
ArtsHERE regarding learning opportuni�es?

3. What strategies or approaches do you recommend to address any challenges regarding learning
opportuni�es?

4. What insights are you learning from the most recent Grantee Learning Opportuni�es Survey
results that could guide future work for NEA and RAOs?

0

Learning Log Topic 4: Grantee Annual Progress Report Data
Log Date: December 2025
Instruc�ons: Learning log ques�ons are designed to prompt though�ul reflec�on and capture valuable
insights into your experiences and lessons learned throughout the planning and implementa�on of
ArtsHERE. Please fill out this learning log based on what you recently learned regarding the summary of
Annual Progress Report data.
1. What is going well regarding the summary of Annual Progress Report data?

2. What challenges or obstacles are you experiencing or observing in the implementa�on of
ArtsHERE regarding the summary of Annual Progress Report data?

3. What strategies or approaches do you recommend to address any challenges regarding the
summary of Annual Progress Report data?

4. What insights are you learning from the summary of Annual Progress Report data that could
guide future work for NEA and RAOs?

1

Instrument 7. Final Descrip�ve Report
OMB No. xxxx-xxxx. Date Approved xxxx. Expires xx/xx/xxxx

PART I: Project Narra�ve
In this sec�on, please respond to each narra�ve ques�on in the text fields provided below. You may cut
and paste the answer into the form from another document, but please limit your response to the
posted character limits. As you exit each text field, it will expand to show your entered text.
Within your narra�ve, please discuss the ac�vi�es funded by your organiza�on’s ArtsHERE grant. Include
any relevant web links to copies of programs, relevant news clippings, or other evidence of your
accomplishments, including evidence of your acknowledgement of Na�onal Endowment for the Arts
(NEA) and Regional Arts Organiza�on (RAO) support.
1. What type of capacity-building project was supported at your organiza�on through ArtsHERE?
This may or may not have changed from your original applica�on. Please select all that apply.
(mul�-select checkbox)
☐ Organizational needs assessment and/or equity planning assessments
☐ Strategic planning or logic model development and/or implementation
☐ Staff development or leadership training (such as cultural competency training for staff
and/or those who develop and implement programming)
☐ Stakeholder and community engagement activities
☐ Field or community research that will help organizations to better document their
commitment to equity as evidenced within their practices and programming and relationship
with their communities
☐ Promotion and marketing activities
☐ Translation services to allow individuals with Limited English Proficiency (LEP) to participate in
programmatic activities
☐ Other capacity-building activities [please specify]: _________________ (500 characters)
2. Describe the capacity-building project ac�vi�es that were supported by ArtsHERE. Please report
solely on ac�vi�es funded by your organiza�on’s ArtsHERE grant. These ac�vi�es must be
consistent with your organiza�on’s final applica�on narra�ve, the approved project budget, and
any approved amendments in accordance with your grantee agreement document. (3,300
characters maximum)
3. Did the project encounter any challenges that disrupted or otherwise hindered your
organiza�on’s ability to conduct the project as planned? (Yes/No check box)
☐ Yes
☐ No
If yes, then please describe the challenge(s) and how you addressed them. (2,000 character
limit)

0

4. Has ArtsHERE, including your par�cipa�on in learning opportuni�es (i.e., e.g., monthly cohorts,
one-on-one coaching, facilitated workshops), in any way strengthened and/or supported
progress towards your organiza�on’s mission and goals?
☐ Yes
☐ No
☐ Unsure – please describe: (3,300 characters maximum)
a. How, if at all, has your organiza�on’s par�cipa�on in ArtsHERE informed its strategies to
sustain or increase equitable access to arts and cultural programs and services for
underserved groups/communi�es? (3,300 characters maximum)
5. To what extent has your organiza�on increased engagement with underserved
groups/communi�es as a result of ArtsHERE?
☐ Not at all
☐ To a small extent
☐ To some extent
☐ To a moderate extent
☐ To a large extent
a. [If respondent selected “to some extent”, “to a moderate extent”, or “to a large extent”
only] How, if at all, has the par�cipa�on of underserved groups/communi�es in your
organiza�on’s arts and cultural programs and services changed as a result of ArtsHERE?
Please consider prac�ces that relate to organiza�onal capacity building and/or
community engagement in arts and cultural programs in your response. (3,300
characters maximum)
6. Please describe any improvements to exis�ng prac�ces and programs or new prac�ces and
programs implemented with the support of ArtsHERE that your organiza�on intends to con�nue
a�er the grant period. Please consider prac�ces that relate to organiza�onal capacity building
and/or community engagement in arts and cultural programs in your response. (3,300 characters
maximum)
7. What early indica�ons of change, if any, could your organiza�on see by the end of your grant
project? Select one or more of these early indica�ons of change from the list below and briefly
explain your selec�on(s) in the text box that follows. If none of these early indica�ons are visible,
please select “none.”
☐ Increased overall organiza�onal capaci�es due to par�cipa�on in learning opportuni�es
☐ Acquired beter or stronger connec�ons between my organiza�on and peers throughout the
country
☐ Improved cultural strategies that engage communi�es my organiza�on serves (cultural
strategies may include ways in which your programs or services are centered in cultural
ac�vi�es, tradi�ons, and iden��es).
☐ Gained deeper understanding of the different ways that communi�es my organiza�on serves
engage in the arts and cultural prac�ce
1

☐ Strengthened my organiza�on’s capacity to sustain or increase engagement with underserved
communi�es
☐ Accomplished or made significant progress toward self-iden�fied goals from the beginning of
the grant period
☐ Other – please describe: (500 characters maximum)
☐ None
a. Please explain your selec�on(s). Include any reflec�ons on the degree and type of capacity
change as well as any data or informa�on that demonstrates the early indica�ons of change
iden�fied above. (5,000 characters maximum)
8. Did any of your rela�onships with these key partners or others expand during the ArtsHERE
performance period? If so, with whom and in what ways? (3,300 characters maximum)

Part II: Popula�on Descriptors
Ques�ons in this sec�on are for research purposes only; your response will not be used in panel
delibera�ons or in making funding decisions related to grant awards you may apply for in the future.
For the next sec�on, please select all racial/ethnic groups of people that your project intended to serve
directly. Then answer the follow-up ques�ons.
9. Select all the racial/ethnic groups of people that your organiza�on makes inten�onal efforts to
engage. Select all that apply and enter addi�onal details in the spaces below.
Racial/Ethnic Groups
No specific Racial/Ethnic Group
☐
American Indian or Alaska Native – Enter, for example, Navajo Nation,
☐
Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native
Village of Barrow Inupiat Traditional Government, Nome Eskimo
Community, Aztec, Maya, etc.
(open comment box) (500 characters maximum)
Asian – Provide details below
☐
☐ Chinese
☐ Vietnamese
☐ Asian Indian
☐ Korean
☐ Filipino
☐ Japanese
Enter, for example, Pakistani, Hmong, Afghan, etc.
(open comment box) (500 characters maximum)
Black or African American – Provide details below
☐
☐ African American
☐ Nigerian
☐ Jamaican
☐ Ethiopian
☐ Haitian
☐ Somali
2

☐

☐

☐

☐

Enter, for example, Trinidadian and Tobagonian, Ghanaian, Congolese,
etc.
(open comment box) (500 characters maximum)
Hispanic or Latino – Provide details below
☐ Mexican
☐ Cuban
☐ Puerto Rican
☐ Dominican
☐ Salvadorian
☐ Guatemalan
Enter, for example, Colombian, Honduran, Spaniard, etc.
(open comment box) (500 characters maximum)
Middle Eastern or North African – Provide details below
☐ Lebanese
☐ Syrian
☐ Iranian
☐ Iraqi
☐ Egyptian
☐ Israeli
Enter, for example, Moroccan, Yemeni, Kurdish, etc.
(open comment box) (500 characters maximum)
Native Hawaiian or other Pacific Islander – Provide details below
☐ Native Hawaiian
☐ Tongan
☐ Samoan
☐ Fijian
☐ Chamorro
☐ Marshallese
Enter, for example, Chuukese, Palauan, Tahitian, etc.
(open comment box) (500 characters maximum)
White – Provide details below
☐ English
☐ Italian
☐ German
☐ Polish
☐ Irish
☐ Scottish
Enter, for example, French, Swedish, Norwegian, etc.
(open comment box) (500 characters maximum)

10. Select all the age groups of people that your organiza�on makes inten�onal efforts to engage.
Age Groups
No specific age group
☐
3

☐
☐
☐
☐

Children/youth (0-17 years)
Young adults (18-24 years)
Adults (25-64 years)
Older Adults (65+ years)

11. When thinking about the underserved groups/communi�es your organiza�on engages, please
select the factors that limit their opportuni�es to benefit from arts programming. Check all that
apply.
Underserved Groups/Communi�es
Geography
☐
☐

Economic Status

☐

Disability

☐
☐

Race or Ethnicity
Other limi�ng factor/s. Please describe: (Text boxes - 100)

12. Please select all the factors below that have limited opportuni�es for underserved
groups/communi�es to benefit from arts programming in your project. Check all that apply.
Limiting Factors
Access and representation: Barriers to accessing arts programming due to
☐
geographical location, economic constraints, or lack of representation within the arts
sector. Limited access to arts institutions, museums, theaters, and galleries.
Financial barriers: Cost associated with participating in arts programming.
☐
Cultural relevance: Arts programming that does not resonate with the cultural
☐
backgrounds and experiences of underrepresented communities. Lack of
representation of diverse voices, stories, and art forms.
Educational disparities: Disparities in arts educational opportunities for
☐
underrepresented communities. Limited resources for arts education.
Systemic discrimination: Discrimination and bias within the arts sector for individuals
☐
from underrepresented communities, including limited opportunities for employment,
exhibition, and recognition. Structural inequities within funding mechanisms, hiring
practices, and artistic programming.
Language and communication: Language barriers; lack of materials and
☐
communications are provided in languages spoken by the community.
Transportation and infrastructure: Limited access for individuals to physically access
☐
arts venues and events.
Other limiting factor/s. Please describe: (1,000 characters maximum)
☐
PAPERWORK REDUCTION ACT STATEMENT

4

The public repor�ng burden for this collec�on of informa�on is es�mated at an average of two and a
half hours per response. This includes the �me for reviewing instruc�ons, searching exis�ng data
sources, gathering and maintaining the data needed, and comple�ng and reviewing the collec�on of
informa�on. We welcome any sugges�ons that you might have on improving the guidelines and making
them as easy to use as possible. Send comments regarding this burden es�mate or any other aspect of
this collec�on of informa�on, including sugges�ons for reducing this burden, to: [email protected],
Aten�on: Repor�ng Burden. Note: Applicants/awardees are not required to respond to the collec�on of
informa�on unless it displays a currently valid U.S. Office of Management and Budget (OMB) control
number. The OMB control number for this survey is OMB No. 3135-XXXX, which expires XX/XX/XXX.

5

6