Form Instrument 5 Instrument 5 Instrument 5: Learning Opportunities Tracker

Attachment A: Instruments
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)
☐ 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
☐ 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)
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)