1 FGP Survey

	OMB No.	3045-0049
	Expiration Date:		April 16, 2007

Note: Dates to be updated based on date of OMB clearance for the information collection.

Your organization has been chosen to complete this survey. Reflecting a national random selection method, your organization represents similar programs we could not include in this year’s assessment. While participation in the survey is voluntary, your response is critical to providing a complete picture of our volunteer programs. The results of this survey will help convey to Congress the accomplishments of the FGP program and will more clearly establish its value to organizations like your own.

Please know that your responses to this data collection will be used only for purposes of this research.  The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific organization or individual.  We will not provide information that identifies individuals or their districts to anyone outside the study team, except as required by law.

COMPLETING THIS SURVEY:

• This survey has been customized to address the types of activities carried out by FGP volunteers for your organization. This determination was based on communications with the Senior Corps Project Director who coordinates with your organization. If you have not received the appropriate survey sections, please contact: Kathy Morehead, survey coordinator at Westat: 1-888-446-1292, or by e-mail, Kathymorehead@Westat.com.

• The survey asks about FGP volunteer activities and accomplishments during the 12-month period from October 1, 2002 to September 30, 2003. For school-based activities and accomplishments, the relevant period is the September 2002-June 2003 school year.

• Please review the Background Section and make corrections to the identifier information as needed.

• Please respond to the sections regarding your volunteers, your organization, and volunteer management.

• Please fill in the next section(s) with information about each of the activities that FGP volunteers carry out for your organization, specifically the numbers of FGP volunteers, FGP volunteer hours, and the nature of the accomplishments for a particular activity. Please avoid duplicating services—select the single best place, in your view, to describe an activity. Please refer to the sample item on page 8 as an example of how to complete the section(s). If numbers are hard to specify, please provide your best estimate.

• Describe any FGP volunteer activity for your organization that does not seem to fit any of the categories included here in the Other Services Section at the end of the survey form.

AFTER YOU HAVE COMPLETED THE SURVEY:

• After completing all parts of the survey, please make a copy for your records.

• Staple originals together and seal them in the envelope that is provided by Westat, the firm contracted to administer the survey.

• Return all sections of the survey to Westat by Friday, May 14. The full address is: Westat, Room RA 1225, 1650 Research Blvd., Rockville, MD 20850. If you wish to fax it: 1-888-377-5716.

If you have any questions about the survey, please contact Westat at (1-888-446-1292, Kathymorehead@Westat.com).

Public reporting burden for this collection of information is estimated to average 45 minutes per submission, including reviewing instructions, gathering and maintaining the data needed, and completing the form. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service, Department of Research and Policy Development, 1201 New York Avenue, N.W., Washington DC 20525.

The Agency 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, which is indicated on this form. (See 5 C.F.R. 1320.5(b)(2)(i))

Background

Your Organization:
Mailing Address:
City/State/ZIP
Person completing the form:
Your Name
Your Title
Your Telephone number:
Your Email:
Is your organization faith-based?				Yes		No

Your volunteerS

Foster Grandparent Volunteers and Your Organization:

(all questions for the period October 1, 2002 through September 30, 2003 or for school year 2002-2003)

Volunteer Information
a. Number of Foster Grandparents during the relevant period (headcount)		FGP volunteers
b. Total Number of Foster Grandparent hours during the relevant period		hours
c. Number of non-Foster Grandparents serving with your organization during the relevant period (headcount)		non-FGP volunteers
d. Of the Foster Grandparents serving with your organization on October 1, 2002, approximately what percentage were still volunteering at the end of the relevant period?
		%
e. How long has the Foster Grandparent program served with your organization? (Please select from the following responses): Under 1 year 1-5 years 6-10 years 11 years or more

Your Organization

Please check the most appropriate boxes for your organization.

HEALTH Hospital/Medical Center/Clinic Hospice Home Health Care Agency Non-Residential Mental Health Agency Non-Residential Developmental Disability Center Residential Long-Term Care Center (MH/MR/DD) Non-vocational Rehabilitation Center Government Agency Other Health Care Organization or Health Department; please specify HUMAN NEEDS Transitional Shelter/Center (Homeless, Battered, etc.) Teen Parenting/Teen Pregnancy Organization Day Care (Pre-Elementary) Center Before and After School Care Organization (including Club/ Church/Community) Government Agency Other Social Service/Human Needs Agency, please specify EDUCATION Head Start Center Non-Head Start Educational Pre-School Public/Private School (K-6/Elementary) Public/Private School (Middle School/Junior High School) Public/Private School (Senior High School) Native American School Vocational Sheltered Workshop/Center Library Museum Government Agency Other Educational Organization, please specify OTHER Other Organization or Agency, please specify	COMMUNITY AND ECONOMIC DEVELOPMENT Community Development Program or Non-Profit Agency Thrift Shop/Coop/Craft Shop Chamber of Commerce Government Agency Other Community and Economic Development Organization or Agency, please specify PUBLIC SAFETY Court Juvenile Correctional Agency Police/Law Enforcement Agency Other Public Safety Organization, please specify
	DISASTER Red Cross Government Agency Other Disaster Organization, please specify
	HOMELAND SECURITY Red Cross Community-based Organization/Agency Government Agency Other Homeland Security Agency, please specify HOUSING Homeless Center Community-based Housing Program Government Agency Other Housing Organization, please specify

VOLUNTEER MANAGEMENT

(For the period October 1, 2002 through September 30, 2003)

1. Please describe the extent to which Foster Grandparents provide the following benefits to your organization. (Check one choice for each statement)

	True to a great extent	True to a moderate extent	Not true	Not applic-able	Don’t Know
a. Foster Grandparents help expand the types of service to clients.					
b. Foster Grandparents help increase the number of clients served.					
c. Foster Grandparents help improve the quality of services provided.					
d. Foster Grandparents help free up paid staff time.					
e. Foster Grandparents bring specialized skills, such as expertise in the education or counseling fields.					
f. Foster Grandparents help increase public support for our organization and/or improve community relations.					
g. The Foster Grandparent project reduces the time and effort needed to recruit volunteers who can help meet our agency’s needs.					
h. Other reason (Specify):					

2. Please describe the extent to which your organization uses tools to manage Foster Grandparents. (Check one choice for each statement)

Management of Foster Grandparent volunteers	Used to a great extent	Used to a moderate extent	Not used	Not applic-able	Don’t Know
a. Written policies and volunteer assignment descriptions for Foster Grandparent volunteers.					
b. Additional liability coverage or insurance protection for Foster Grandparent volunteers beyond what Senior Corps already offers.					
c. Recognition activities, such as award ceremonies, for Foster Grandparent volunteers.					
d. Regular collection of information on numbers and hours of Foster Grandparent volunteers.					
e. Annual measurement of the impacts of Foster Grandparent volunteers.					
f. Training and professional development activities for volunteers.					
g. Screening procedures to identify suitable Foster Grandparent volunteers, and to match them with appropriate tasks or jobs.					
h. Regular supervision of and communication with Foster Grandparent volunteers.					

3. We are interested in knowing if anyone in your organization is primarily responsible for volunteer management. (Please check “yes” or “no”)

Staff responsibility for volunteer management	Yes	No	Don’t know
a. Does your organization have a paid staff person whose responsibilities include management of volunteers?		 (Go to Item 4)	
b. Does your organization have a volunteer who is responsible for the management of other volunteers?			

4. Some organizations encounter challenges with Foster Grandparents or the Foster Grandparent project. Please note the degree to which each of the following issues has been a challenge for your organization. (Please check one choice for each statement below)

Challenges in the development of Foster Grandparent volunteer assignments	A major challenge	A minor challenge	Not a challenge at all	Not Applic-able	Don’t Know
a. Responsiveness of the Foster Grandparent project when:
More Foster Grandparent volunteers are requested.					
Foster Grandparent volunteers with the right skills or expertise are needed.					
Foster Grandparent volunteers are needed for specific schedules.					
b. Lack of paid staff time to properly train and supervise Foster Grandparent volunteers.					
c. Lack of adequate funds for supporting Foster Grandparent volunteer involvement.					
d. Regulatory, legal, or liability constraints on Foster Grandparent volunteer involvement.*					
e. Absenteeism, unreliability, or low quality service provided by Foster Grandparent volunteers.					
f. Other challenge (Specify):					

* constraints might include reporting, background checks, or liability insurance

5. To what extent would each of the following factors increase your capacity to involve volunteers in service (both Foster Grandparent and non-Foster Grandparent)?

	Would increase to a great extent	Would increase to a moderate extent	Would not increase at all	Don’t Know
a. More training or professional development in how to work more effectively with volunteers.				
b. Greater availability of potential volunteers with specialized skills, such as legal, financial management, or computer expertise.				
c. A one-year, full-time volunteer with a living stipend, and with responsibility for volunteer recruitment and management.				
d. Fewer regulatory, legal, or liability constraints on volunteer involvement.				
e. More information about people in the community who want to volunteer.				
f. Other factor (Specify):				

6. We’d like to know about the methods your organization uses to locate and recruit Foster Grandparent volunteers. Does your organization…

	Yes	No	Not applic- able	Don’t Know
a. Do public speaking before groups?				
b. Use radio?				
c. Use the Senior Corps JASON web-based recruitment system?				
d. Use other (non-JASON) Internet recruiting system(s)?				
e. Use television?				
f. Use newspapers, trade papers, billboards, or fliers?				
g. Register with other organizations to receive referrals?				
h. Use special events, such as volunteer fairs or organizational open houses?				
i. Use word of mouth?				
j. Other method (Specify):

Sample Foster Grandparent Volunteer Activity

Below is an example of how to complete the items regarding accomplishments.

Sample. Delivery of Health Services

N umber of Foster Grandparents who provided these services:	10
Total number of Foster Grandparent Volunteer hours:	1,000

Type of Service	Number
Provided nurturing or support at a clinic, hospital, hospice, or mobile-unit to	100	very sick or terminally ill children.
Fed, cradled, sang, and rocked	100	infants.

HUMAN NEEDS: HEALTH/NUTRITION (HN)

HN-a. Total estimated number of people who benefited:

Please complete those items that are relevant to your FGP volunteers for the period October 1, 2002 through September 30, 2003.

HN-1. Delivery of Health Services

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided nurturing or support at a clinic, hospital, hospice, or mobile-unit to		very sick or terminally ill children.
Provided information on the delivery of health services to		parents and/or children.
Helped with the preparation for and recovery of		children who had operations.
Fed, cradled, sang to, and rocked		infants.
Visited with/nurtured		hospitalized children.

HN-2. Maternal/Child Health Services

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided support/services for post-natal care and well-child clinics for		children.
Helped with pre-natal care and healthy living assistance to		pregnant adolescents.

HN-3. Mental Health

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided services for		children with mental health impairments who receive non-residential support services.
Provided services for		children receiving residential mental health support services.

HN-4. Developmental Disabilities

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided services in residential or non-residential settings for		children with developmental disabilities.

HN-5. Substance Abuse

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided services to		drug or alcohol addicted infants.
Provided services to		drug or alcohol addicted children or teens.
Helped with rehabilitation services for		young substance abusers and their families.

HN-6. Physical Disabilities Programs

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided assistance with rehabilitation, therapy, or exercise to		children with physical disabilities.
Assisted during Special Olympics with		children with physical disabilities.

HN-7. In-Home Care

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided supportive health and social services for		children needing long term care in their homes.

HN-8. Hospice/Terminally Ill

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided nurturing and support to		terminally ill children (except those with HIV/AIDS) and their families.

HN-9. Boarder Babies

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Cared for		infants or young children who were hospitalized because of lack of placement alternatives (except for children with HIV/AIDS).

HN-10. HIV/AIDS

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Cared for		boarder babies with HIV/AIDS.
Provided nurturing and support to		HIV/AIDS positive children living in their homes.
Provided nurturing and support to		HIV/AIDS positive children living with relatives or foster families.
Provided nurturing and support to		HIV/AIDS positive children in hospices and hospitals.

HN-11. Other Health/Nutrition Services

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Please specify these other health/nutrition services:
(1) , to…		people.
(2) , to…		people.
(3) , to…		people.

OTHER HUMAN NEEDS and housing (O)

O-a. Total estimated number of people who benefited:

Please complete those items that are relevant to your FGP volunteers for the period October 1, 2002 through September 30, 2003.

O-1. Crisis Intervention

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Participated in crisis intervention programs serving		children.

O-2. Homeless

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided services to		homeless children.

O-3. Mentoring

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided mentoring by developing relationships, reinforcing prosocial behaviors and providing constructive guidance and feedback to		children.
Provided mentoring by developing relationships, reinforcing prosocial behaviors and providing constructive guidance and feedback to		children of prisoners.
Provided mentoring by developing relationships, reinforcing prosocial behaviors and providing constructive guidance and feedback to		children in foster care.
Nurtured and supported		children, teens, and young adults.

O-4. Respite

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided respite for		caregivers of special needs children.

O-5. Teen Pregnancy/Parenting Support and Education

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided support services for		teen parents.
Provided one-on-one services on parenting skills, child health and safety and similar topics for		teen parents.

O-6. Child Abuse/Neglect

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided aid, assistance, and guidance to		abused/neglected children and their families.
Provided information or referrals on child abuse prevention to		teenage parents.

O-7. Other Human Needs Services

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Please specify these other human needs services:
Type of Service	Number
(1) , to…		people.
(2) , to…		people.
(3) , to…		people.

EDUCATION (ED)

ED-a. Total estimated number of people who benefited:

Please complete those items that are relevant to your FGP volunteers for the period October 1, 2002 through September 30, 2003.

ED-1. Pre-Elementary Day Care

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Assisted at		pre-elementary learning and day care programs (not including Head Start).
Assisted in pre-elementary and day care programs (not including Head Start) for		children.

ED-2. Head Start

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided mentoring in Head Start Programs by developing relationships with children, reinforcing prosocial behaviors, and providing constructive guidance and feedback to		children in Head Start.
Helped		children in Head Start to develop social and behavioral skills.
Provided emotional support and nurturing for		children in Head Start.
Provided child development and school readiness skills activities for		children in Head Start.
Provided meals, nutritional information, and monitored child health status for		children in Head Start.

ED-3. Elementary Education

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided one-on-one assistance in		elementary school classrooms.
Provided one-on-one assistance for		elementary school students.
Assisted and support child participation in extracurricular activities, clubs, physical education classes, physical fitness or sports programs involving		elementary school students.

ED-4. Secondary Education

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided one-on-one assistance in		7th through 12th grade classrooms.
Provided one-on-one assistance for		students in 7th through 12th grade.
Assisted and support child participation in extracurricular activities, clubs, physical education classes, physical fitness or sports programs involving		students in 7th through 12th grade.

ED-5. Special Education

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided supportive services to		students with learning disabilities in kindergarten through 6h grade.
Provided supportive services to		students with learning disabilities in 7th through 12th grade.
Assisted in		other special education programs.
Assisted in other special education programs involving		students in kindergarten through 12h grade.

ED-6. Tutoring and Child Literacy

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Used evidence-based reading readiness programs with		students in pre-K.
Used evidence-based reading and tutoring programs with		students in kindergarten through 6th grade.
Used evidence-based reading and tutoring programs with		students in 7th through 12th grade.
Provided tutoring and support in math, science, social science, and other subjects to		students.

ED-7. Job Preparedness/Vocational Education

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Assisted in job skills training in		education programs.
Assisted in job skills training for		students.

ED-8. ESL

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Used evidence-based programs for		ESL students (from kindergarten through high school) to learn English.

ED-9. GED

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Assisted		students working toward their GED.

ED-10. Other Education Services

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Please specify these other education services:
(1) , to…		people.
(2) , to…		people.
(3) , to…		people.

PUBLIC SAFETY (pS)

PS-a. Total estimated number of people who benefited:

Please complete those items that are relevant to your FGP volunteers for the period October 1, 2002 through September 30, 2003.

PS-1. Offender/Ex-offender Services/Rehabilitation

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Provided one-on-one support to		young offenders/ex-offenders.
Mentored		young offenders/ex-offenders.
Provided one-on-one support and nurturing to		children of offenders/ex-offenders.

PS-2. Family Violence

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Supported		children whose families are in violence prevention programs.

PS-3. Safe Children and Youth

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Helped children understand, learn, and practice safety issues such as crime and fire prevention, being aware of one’s surroundings, and personal responsibility for safety to		children.

PS-4. Other Public Safety

Number of Foster Grandparents who provided these services:
Total number of Foster Grandparent Volunteer hours:

Type of Service	Number
Please specify these other public safety services:
(1) , to…		people.
(2) , to…		people.
(3) , to…		people.

DISASTER (D)

D-a. Total estimated number of people who benefited:

Please complete those items that are relevant to your FGP volunteers for the period October 1, 2002 through September 30, 2003.

D-1. Disaster Preparedness

Number of FGP Volunteers who provided these services:
Total number of FGP Volunteer hours:

Type of Service	Number
Helped children understand, cope with, or prepare for emergencies		children.

D-2. Other Disaster Services

Number of FGP Volunteers who provided these services:
Total number of FGP Volunteer hours:

Type of Service	Number
Please specify these other disaster services:
(1) , to…		people.
(2) , to…		people.
(3) , to…		people.

HOMELAND SECURITY (HS)

The Homeland Security area includes programs that prepare to minimize the damage and recover from any future terrorist attacks that may occur despite our best efforts at prevention. This includes programs that help to plan, equip, train, and practice the response capabilities [of] many different response units (including first responders, such as police officers, firefighters, emergency medical providers, public works personnel, and emergency management officials) ready to mobilize without warning for any emergency. This area also includes programs that will consolidate federal response plans and build a national system for incident management in cooperation with state and local government including emergency preparedness and response efforts to engage the private sector and the American people.

HS-a. Total estimated number of people who benefited:

Please complete those items that are relevant to your FGP volunteers for the period October 1, 2002 through September 30, 2003.

HS-1. Emergency Preparedness

Number of FGP Volunteers who provided these services:
Total number of FGP Volunteer hours:

Type of Service	Number
Helped children understand, cope with, or prepare for emergencies		children.

OTHER SERVICES (OS)

Activity not included in survey	Specific activity performed by Foster Grandparent Volunteers	Number of Volunteers Performing Activity	Total Number of Hours Spent on Activity	Number of People Served by the Activity
Language Assistance	Language interpretation	8	200	16

Please add any additional information on the reverse side of this page.

8 FGP-B