1 RSVP 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 RSVP 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 RSVP 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.

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

• The survey asks about RSVP 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 fill in the next section(s) with information about each of the activities that RSVP volunteers carry out for your organization, specifically the numbers of RSVP volunteers, RSVP 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 9 as an example of how to complete the section(s). If numbers are hard to specify, please provide your best estimate.

• Describe any RSVP 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 this form:
Your Name
Your Title
Your Telephone number:
Your Email:
Is your organization faith-based?				Yes		No

Your volunteerS

RSVP 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 RSVP Volunteers during the above period (headcount)		RSVP volunteers
b. Total Number of RSVP Volunteer hours during the above period		hours
c. Number of non-RSVP Volunteers serving with your organization during the above period (headcount)		non-RSVP volunteers
d. Approximately how many of these non-RSVP volunteers were recruited, trained, managed, or coordinated by RSVP volunteers?
		non-RSVP volunteers
e. Of the RSVP Volunteers serving with your organization on October 1, 2002, approximately what percentage were still volunteering at the end of the relevant period?
		%
f. How long has the RSVP 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 all boxes that describe your organization:

HEALTH Hospital/Medical Center/Clinic Nursing Home/Convalescent Center/Hospice Home Health Care Agency Non-Residential Mental Health Agency Non-Residential Developmental Disability/ Rehabilitation Center Residential Long-Term Care Agency (MH/MR/DD) Congregate Meal/Meals on Wheels Agency Food Bank Government Agency Other Health Care Organization or Health Department; please specify HUMAN NEEDS Adult Day Care Center Transitional Shelter/Center (Homeless, Battered, etc.) Multi-Purpose Center (including senior centers) Public Housing Agency Day Care (Pre-Elementary) Center 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 Post Secondary Institution Library Museum Adult Education Organization Government Agency Other Educational Organization, 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 Adult 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 Other Community-based Organization/Agency Government Agency Other Homeland Security Agency, please specify ENVIRONMENT Parks/Recreation Agency Animal Care Organization Community Based Environmental Organization Government Agency Other Environmental Organization, please specify

HOUSING Homeless Center Housing Referrals/Relocation Agency Housing Rehabilitation/Construction Organization Transitional Housing Center/Organization Community-based Housing Organization Government Agency Other Housing Organization, please specify

OTHER Other Organization or Agency, please specify

VOLUNTEER MANAGEMENT

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

1. Please describe the extent to which RSVP volunteers 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. RSVP volunteers help expand the types of service to clients.					
b. RSVP volunteers help increase the number of clients served.					
c. RSVP volunteers help improve the quality of services provided.					
d. RSVP volunteers help free up paid staff time.					
e. RSVP volunteers bring specialized skills, such as legal, financial management, or computer expertise.					
f. RSVP volunteers help increase public support for our organization and/or improve community relations.					
g. RSVP volunteers help recruit other volunteers (non-RSVP).					
h. RSVP volunteers help manage other volunteers (non-RSVP).					
i. The RSVP project reduces the time and effort needed to recruit volunteers who can help meet our agency’s needs.					
j. Other reason (Specify):					

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

Management of RSVP 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 RSVP volunteers.					
b. Additional liability coverage or insurance protection for RSVP volunteers beyond what Senior Corps already offers.					
c. Recognition activities, such as award ceremonies, for RSVP volunteers.					
d. Regular collection of information on numbers and hours of RSVP volunteers.					
e. Annual measurement of the impacts of RSVP volunteers.					
f. Training and professional development activities for volunteers.					
g. Screening procedures to identify suitable RSVP volunteers, and to match them with appropriate tasks or jobs.					
h. Regular supervision of and communication with RSVP 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 RSVP or the RSVP 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 RSVP volunteer assignments	A major challenge	A minor challenge	Not a challenge at all	Not applic-able	Don’t Know
a. Responsiveness of the RSVP project when:
More RSVP volunteers are requested.					
RSVP volunteers with the right skills or expertise are needed.					
RSVP volunteers are needed for specific schedules.					
b. Lack of paid staff time to properly train and supervise RSVP volunteers.					
c. Lack of adequate funds for supporting RSVP volunteer involvement.					
d. Regulatory, legal, or liability constraints on RSVP volunteer involvement.*					
e. Absenteeism, unreliability, or low quality service provided by RSVP 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 RSVP and non-RSVP)?

	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 RSVP 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 RSVP Volunteer Activity

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

Sample. Delivery of Health Services

N umber of RSVP Volunteers who provided these services:	30
Total number of RSVP Volunteer hours:	3,000

Type of Service	Number
Provided escort and support services in community clinics, home health agencies, and other health settings to	150	people.
Provided health services at a clinic, hospital, mobile-unit, skilled nursing facility, or adult day care center to	500	people.

HUMAN NEEDS: HEALTH/NUTRITION (HN)

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

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

HN-1. Delivery of Health Services

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

Type of Service	Number
Provided escort and support services in community clinics, home health agencies, and other health settings to		people.
Provided health services at a clinic, hospital, mobile-unit, skilled nursing facility, or adult day care center to		people.
Provided information, class enrollment, or referrals on the delivery of health services to		people.
Helped people to prepare for/recover from hospital stays and operations; helped		people.

HN-2. Health Education

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

Type of Service	Number
Taught health practices, including first aid or CPR, to		people.
Provided information, class enrollment or referrals for health services, including first aid or CPR, to		people.

HN-3. Maternal/Child Health Services

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

Type of Service	Number
Provided support/services for post-natal care and well-child clinics for		children.
Provided pre-natal care and family planning services and support for		women.
Provided information, referrals, and class enrollment on pre-and post-natal care, and child health for		women.

HN-4. Mental Health

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

Type of Service	Number
Helped deliver services to mental health patients in residential and non-residential settings; helped		mental health patients.
Disseminated information, or provided out-patient planning or reality orientation for		mental health patients.
Provided information, program enrollment, or referrals on mental health to		people.

HN-5. Congregate Meals

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

Type of Service	Number
Prepared and/or served food, cleaned up, planned menus or assisted with recordkeeping for		meals.
Prepared and/or served food, cleaned up, planned menus or assisted with recordkeeping for		people.

HN-6. Developmental Disabilities

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

Type of Service	Number
Assisted in programs or advocacy for		individuals with developmental disabilities.
Provided information, program enrollment or referrals on programs serving individuals with developmental disabilities		people.
Provided services in residential or non-residential settings for		individuals with developmental disabilities.

HN-7. Substance Abuse

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

Type of Service	Number
Provided rehabilitation services to		people with substance addictions and their families.
Disseminated informational fliers on the abuse of alcohol, drugs, and over the counter medications, to		people.
Provided services for		drug or alcohol addicted infants.
Provided services for		drug or alcohol addicted adults.
Provided services for		drug or alcohol addicted children or teens.

HN-8. Physical Disabilities Programs

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

Type of Service	Number
Assisted during Special Olympics with		participants.
Provided information, program enrollment, or referrals on physical disabilities to		people.
Provided rehabilitation and exercise assistance to		people with physical disabilities.

HN-9. In-Home Care

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

Type of Service	Number
Provided supportive health and social services for		individuals who needed long term care in their homes.
Provided information, program enrollment or referrals on in-home care to		people.
Provided services such as light housekeeping, meal preparation, referral and service coordination to		individuals who needed long term care in their homes.

HN-10. Hospice/Terminally Ill

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

Type of Service	Number
Provided information, program enrollment, or referrals on terminal illness and hospice to		people.
Provided nurturing and support to		terminally ill patients (except for those with HIV/AIDS) and their families.

HN-11. Food Distribution/Collection

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

Type of Service	Number
Delivered meals to		individuals in their homes.
Delivered		meals.
Distributed informational fliers on food distribution and collection to		people.
Gleaned, organized, packed, or distributed		pounds of food for a food bank.
Gleaned, organized, packed, or distributed food for		people.
Participated in nutrition education services attended by		people.

HN-12. Boarder Babies

Number of RSVP Volunteers who provided these services:
Total number of RSVP 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-13. HIV/AIDS

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

Type of Service	Number
Cared for		boarder babies with HIV/AIDS.
Provided information, program enrollment or referrals on HIV/AIDS programs to		people.
Provided services and support for		HIV/AIDS patients in institutions and hospices, and their families.
Provided services and support for		HIV/AIDS patients in their own or their families’ homes.

HN-14. Immunization

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

Type of Service	Number
Assisted in providing immunizations in clinics, hospitals, and other community-based settings to		people of all ages.
Assisted in providing school immunizations to		children.
Urged parents to obtain follow-up immunizations for		infants.
Provided information, clinic enrollment or referrals on immunizations to		people.

HN-15. Other Health/Nutrition Services

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

Type of Service	Number
Provided information program/class enrollment or referrals on other health and nutrition services to		people.
Please specify these other health/nutrition services:
Type of Service	Number
(1) , to…		people.
(2) , to…		people.
(3) , to…		people.

OTHER HUMAN NEEDS (O)

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

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

O-1. Adult Day Care

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

Type of Service	Number
Coordinated and/or provided services at adult day care centers for		older individuals.

O-2. Companionship/Outreach

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

Type of Service	Number
Provided support, wrote letters, listened, read or spoke to		people to ease their feelings of isolation and loneliness.
Visited, called or provided bereavement support to		people.
Visited with		hospitalized patients.

O-3. Crisis Intervention

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

Type of Service	Number
Participated in crisis intervention programs serving		people of all ages.
Provided information or referrals on crisis intervention services to		people.
Provided telephone/hotline crisis counseling to		people.

O-4. Family Violence

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

Type of Service	Number
Helped		victims of family violence.
Provided information, program enrollment, or referrals on family violence to		people.
Provided training in prevention awareness and self defense to		people.

O-5. Child Abuse/Neglect

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

Type of Service	Number
Provided aid, assistance, and guidance to		child victims of abuse or neglect, and their families.
Provided information, program enrollment, or referrals on child abuse to		people.
Served as guardians ad litem (legally-appointed) to		abused/neglected children.

O-6. Mentoring

Number of RSVP Volunteers who provided these services:
Total number of RSVP 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 in foster care.
Mentored		children of prisoners.
Coordinated group activities for		children of prisoners.
Distributed holiday gifts to		children of prisoners.
Provided advocacy for		children of prisoners.

O-7. Respite

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

Type of Service	Number
Provided information, program enrollment, or referrals on respite programs to		people.
Provided respite for		caregivers.

O-8. Teen Pregnancy/Parenting Support and Education

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

Type of Service	Number
Conducted parenting classes for		teen parents.
Provided informational materials to		teen parents.
Provided one-on-one services on parenting skills, child health and safety and similar topics for		teen parents.
Provided teen pregnancy information, program enrollment, or referrals to		people.
Helped recruit and train		volunteers for teenage pregnancy prevention programs.

O-9. Senior Center Programs

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

Type of Service	Number
Coordinated and/or delivered supportive services or social activities for		people at senior centers.

O-10. Elder Abuse/Neglect

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

Type of Service	Number
Assisted		abused elders and their families.
Conducted		elder abuse prevention programs.
Conducted elder abuse prevention programs attended by		people.

O-11. CHIPS/SCHIPS

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

Type of Service	Number
Enrolled		people in these programs.
Provided information or referrals about CHIPS/SCHIPS to		people.

O-12. Other Human Needs Services

Number of RSVP Volunteers who provided these services:
Total number of RSVP 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 RSVP volunteers for the period October 1, 2002 through September 30, 2003.

ED-1. Pre-Elementary Day Care

Number of RSVP Volunteers who provided these services:
Total number of RSVP 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) serving		children.

ED-2. Head Start/School Preparedness

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

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

ED-3. Elementary Education

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

Type of Service	Number
Served as classroom aides, playground aides, one-on-one student assistants, or computer aides in		elementary school classrooms.
Served as classroom aides, playground aides, one-on-one student assistants, or computer aides for		elementary school students.
Assisted with extracurricular activities, clubs, physical education classes, physical fitness or sports programs involving		elementary school students.
Participated in character education programs, including anti-bullying programs for		elementary school students in schools.
Participated in character education programs, including anti-bullying programs for		elementary school students in community settings.

ED-4. Secondary Education

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

Type of Service	Number
Served as field trip aides, teacher’s aides, one-on-one classroom assistants, or career counselors in		7th through 12th grade classrooms.
Served as field trip aides, teacher’s aides, one-on-one classroom assistants, or career counselors for		students in 7th through 12th grade.
Assisted with extracurricular activities, clubs, physical education classes, physical fitness or sports programs involving		students in 7th through 12th grade.
Participated in character education programs, including anti-bullying programs for		secondary school students in schools.
Participated in character education programs, including anti-bullying programs for		secondary school students in community settings.

ED-5. Special Education

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

Type of Service	Number
Assisted in special education programs involving		students in kindergarten through 6h grade.
Assisted in special education programs involving		students in 7th through 12h grade.

ED-6. Tutoring and Child Literacy

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

Type of Service	Number
Assisted in job skills training in		education programs.
Assisted in job skills training for		people.
Provided information, program enrollment, or referrals on job preparedness programs to		people.

ED-8. Library Services

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

Type of Service	Number
Helped at		libraries.
Started or operated		bookmobiles.
Started or operated bookmobiles serving		people.

ED-9. Cultural Heritage

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

Type of Service	Number
Developed and/or presented		programs about cultural preservation and enrichment (e.g., historic preservation, oral history, museums, drama, the arts).
Developed and/or presented programs about cultural preservation and enrichment to		people.

ED-10. ESL

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

Type of Service	Number
Provided information, program enrollment, or referrals on ESL programs to		people.
Helped		ESL students (from kindergarten through high school) to learn English.
Helped		adult ESL students to learn English.

ED-11. GED/Dropouts

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

Type of Service	Number
Provided information, program enrollment, or referrals on GED programs to		people.
Tutored		students for their GED.

ED-12. Service Learning

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

Type of Service	Number
Reflected on their volunteer experiences and described their insights concerning service, client advocacy, social issues and their own lives by		volunteers.
Coordinated or expanded service-learning opportunities for elementary school students in		schools.
Coordinated or expanded services-learning opportunities for		elementary school students.
Coordinated or expanded service-learning opportunities for middle school students in		schools.
Coordinated or expanded services-learning opportunities for		middle school students.
Coordinated or expanded service-learning opportunities for high school students in		schools.
Coordinated or expanded services-learning opportunities for		high school students.

ED-13. Adult Education and Literacy

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

Type of Service	Number
Provided literacy assistance to		adults.
Recruited and trained		volunteers for literacy programs.

ED-14. Other Education Services

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

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

ENVIRONMENT (ENV)

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

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

ENV-1. Waste Reduction/Management/Recycling

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

Type of Service	Number
Conserved, stored, treated, or disposed of		pounds of waste.
Created or staffed		recycling centers or neighborhood pick-up programs.
Recycled		pounds of materials.

ENV-2. Environmental Awareness

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

Type of Service	Number
Developed a directory of		environmental groups.
Distributed directories of environmental groups to		people.
Developed or participated in		environmental education, information programs or presentations (e.g., awareness campaigns, environmental fairs, nature walks).
Developed or participated in environmental education, information programs or presentations attended by		people.
Distributed environmental awareness materials to		people.
Disseminated information or fact sheets or made presentations about environmental hazards and health to		people.

ENV-3. Clean Air

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

Type of Service	Number
Tested and monitored air quality in		locations.

ENV-4. Clean and Safe Waters

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

Type of Service	Number
Adopted and cleaned		beaches and streams.
Monitored		taps for water quality.
Set up		ground water and surface protection programs.
Tested		wells, streams, and water tanks.

ENV-5. Energy Conservation

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

Type of Service	Number
Conducted information campaigns on energy saving devices reaching		people.
Winterized and weatherized		homes or community buildings.

ENV-6. Indoor Environment

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

Type of Service	Number
Cleaned up (excluding making repairs and providing housing services) for		contaminated housing units.
Cleaned up contaminated housing units for		people.
Tested		buildings and homes for pollutants such as lead, radon, smoke and asbestos.

ENV-7. Wildlife, Land, and Vegetation Protection and Restoration

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

Type of Service	Number
Developed and/or participated in		activities aimed at reducing wildlife mortality due to pesticides.
Participated in activities to reduce wildlife mortality affecting		acres of wildlife habitat.
Restored or protected		acres of degraded land.
Restored or protected		miles of degraded land.

ENV-8. Other Environmental Services

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

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

COMMUNITY AND ECONOMIC DEVELOPMENT (C)

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

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

C-1. Consumer Education

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

Type of Service	Number
Developed and/or participated in information campaigns on consumer issues (e.g., health and life insurance, estate counseling, and consumer protection) reaching		people.

C-2. Transportation Services

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

Type of Service	Number
Developed and/or operated		transportation systems.
Developed and/or operated transportation systems used by		people.
Helped drive		people on errands, doctor visits, or between facilities.
Helped drive people on errands, doctor visits, or between facilities for		miles.

C-3. Community Improvement

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

Type of Service	Number
Constructed/renovated		playgrounds.
Constructed/renovated playgrounds used by		children and families.
Removed trash or abandoned cars, cleaned, removed graffiti, repaired fences, and provided landscaping at		community areas.

C-4. Community-based Volunteer Programs

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

Type of Service	Number
Recruited and coordinated		RSVP volunteers.
Recruited		non-RSVP volunteers.
Trained and coordinated		RSVP volunteers.
Trained and coordinated		non-RSVP volunteers.
Led team building activities for		volunteers.

C-5. Food Production/Community Gardens/Farming

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

Type of Service	Number
Established, expanded, or revitalized		acres of community gardens.
Established, expanded, or revitalized community gardens used by		people.
Participated in		community gardening programs, alternative crop programs, or improved food growing programs.
Participated in community gardening programs, alternative crop programs, or improved food growing programs serving		people.
Grew		pounds of food.
Grew food used by		people.

C-6. Management Consulting

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

Type of Service	Number
Volunteer executives provided assistance to expand or improve the operation of		private, non-profit or public agencies.
Volunteer executives provided assistance to expand or improve the operation of private, non-profit, or public agencies serving		people.

C-7. Small and Minority Business Development

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

Type of Service	Number
Assisted		small or minority businesses.
Assisted small or minority businesses operated by		people.

C-8. Tax Consulting/Counseling

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

Type of Service	Number
Assisted or trained		people to do their taxes.
Trained		people to be tax counselors/preparers.
Prepared tax returns for		people.

C-9. Thrift Store

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

Type of Service	Number
Organized or started		thrift stores.
Organized or started thrift stores providing affordable goods bought by		people.

C-10. Other Community and Economic Development Services

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

Type of Service	Number
Please specify these other community and economic development 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 RSVP volunteers for the period October 1, 2002 through September 30, 2003.

PS-1. Safety/Fire Prevention/Accident Prevention

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

Type of Service	Number
Coordinated or participated in		safety programs (such as fire prevention, auto safety, traffic/pedestrian control programs).
Coordinated or participated in safety programs attended by		people.

PS-2. Adult Offender/Ex-Offender Services

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

Type of Service	Number
Coordinated or participated in rehabilitation services for		adult offenders/ex-offenders.
Provided information, program enrollment or referrals on offender/ex-offender services to		people.

PS-3. Juvenile Justice, Delinquency, Gangs

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

Type of Service	Number
Coordinated or participated in rehabilitation services for		youth offenders/ex-offenders.
Provided one-on-one support and nurturing to		youth offenders/ex-offenders.
Served as mentors to		youth offenders/ex-offenders.

PS-4. Crime Awareness/Crime Avoidance

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

Type of Service	Number
Identified		unsafe areas.
Provided fingerprinting services to		people.
Provided safety escort services to		people.
Providing training in ways to avoid victimization (e.g., direct deposit, scam alerts, tourist safety) to		people.

PS-5. Victim/Witness Assistance

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

Type of Service	Number
Assisted		crime victims.

PS-6. Community Policing/Community Patrol

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

Type of Service	Number
Developed or participated in		police district patrols or citizen patrols.
Worked with		local police and community organizations to insure safer neighborhoods.
Helped direct traffic at		events.
Helped to trace abandoned cars, followed up with victims, or did other administrative work on behalf of		people.
Conducted		foot patrols.
Conducted foot patrols freeing up		hours of police officer time.

PS-7. Conflict Resolution/Mediation

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

Type of Service	Number
Educated		people about gang activity.
Mentored		gang members.
Started or participated in		peer mediation programs and youth courts.
Started or participated in peer mediation programs or youth courts serving		juveniles.
Provided training in conflict resolution/conflict mediation techniques and violence prevention to		people.
Provided conflict resolution assistance to		people.

PS-8 Improvement of Household Security

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

Type of Service	Number
Conducted		workshops on household safety.
Conducted workshops on household safety attended by		people.
Conducted		security audits and surveys.
Conducted security audits and surveys for		households.
Installed		new windows, door locks, or window bars.
Installed new windows, door locks, or window bars for		households.

PS-9. Neighborhood Watch/Block Watch

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

Type of Service	Number
Developed or participated in		neighborhood watch programs.
Developed or participated in neighborhood watch programs serving		people.

PS-10. Sexual Abuse/Rape

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

Type of Service	Number
Provided support to		sexual assault/harassment victims.
Started/expanded		shelters for sexual assault/harassment victims.
Started/expanded shelters benefiting		sexual assault/harassment victims.
Provided sexual abuse, awareness, and self-defense training to		people.

PS-11. Other Public Safety

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

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

HOUSING (h)

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

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

H-1. Homeless

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

Type of Service	Number
Participated in programs to help the homeless (except for housing referrals) attended by		people.

H-2. Home Management

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

Type of Service	Number
Provided training on application processing, mortgages, taxes, upkeep and home maintenance for		people.
Distributed information on home ownership to		people.
Helped		people with budgeting, financial planning, and filling out forms and bills.

H-3. Housing Referrals/Relocation/Other

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

Type of Service	Number
Obtained household furnishings for		households.
Made housing referrals for		people.

H-4. Housing Rehabilitation/Construction

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

Type of Service	Number
Helped build, repair, inspect, or rehabilitate		homes.
Helped build, repair, inspect, or rehabilitate homes for		people.
Recruited and supported		volunteers for housing rehabilitation and construction.

H-5. Other Housing Services

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

Type of Service	Number
Please specify these other housing 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 RSVP volunteers for the period October 1, 2002 through September 30, 2003.

D-1. Disaster Preparedness

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

Type of Service	Number
Participated in response, relief, recovery and mitigation during		emergencies/fires/natural disasters.
Participated in response, relief, recovery and mitigation during emergencies/fires/natural disasters affecting		people.
Provided natural disaster preparedness training (such as Red Cross training) to		people.
Provided natural disaster preparedness training to		people.
Provided information, class enrollment, or referrals on natural disaster preparedness to		people.
Were on “on-call” lists for		emergencies or needs.
Prepared disaster plans for		agencies.
Gave presentations to		groups of people attending.

D-2. Other Disaster Services

Number of RSVP Volunteers who provided these services:
Total number of RSVP 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 RSVP volunteers for the period October 1, 2002 through September 30, 2003.

HS-1. Disaster Preparedness

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

Type of Service	Number
Participated in response, relief, recovery and mitigation during		emergencies.
Participated in response, relief, recovery and mitigation during emergencies affecting		people.
Provided homeland security training (such as Red Cross and CERTS training) to		people.
Provided homeland security preparedness training to		people.
Provided information, class enrollment, or referrals on homeland security disaster preparedness to		people.

HS-2. Public Safety

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

Type of Service	Number
Mobilized		volunteers to assist first responders (e.g., police, fire fighters) during disasters.
Performed administrative duties so that		fire departments, police departments, and other public service agencies were able to prepare and respond to emergencies.

HS-3. Public Health

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

Type of Service	Number
Provided assistance to		medical and emergency medical personnel
Coordinated emergency supplies and established coordination links during		emergencies.

HS-4. Homeland Security Services

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

Type of Service	Number
Made educational presentations on homeland security (e.g., Bioterrorism, terrorist attacks) to		community groups.
Assisted individuals and families during		disasters.
Provided support services (e.g., fundraising, answering questions, distributing food) for		organizations involved in emergency and disaster relief.
Taught classes in safety, fire prevention, basic first aid, and/or CPR to		adults and/or children.
Provided information and referral services during disasters and emergencies to		people.

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

OTHER SERVICES (OS)

Activity not included in survey	Specific activity performed by RSVP 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.

10 RSVP-B