1 LASSIE Survey K12 HED CBO

Learn and Serve America Program and Performance Reporting System (LASSIE)

2011 LASSIE Survey K12 HED CBO Grants 09 08 10

Learn and Serve America Program and Performance Reporting System (LASSIE)

OMB: 3045-0095

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2010-2011 Program and Performance Measurement Report

K-12, HED, CBO Grants




Please fill out all relevant sections of this form completely.


The Grant Profile Information (pages 4-5 of this form) should be completed by any organization receiving Learn and Serve America funds (grantees, subgrantees, organizations receiving grants from subgrantees).


The Program Reporting Form (beginning on page 6) should be completed by Learn and Serve America grantees, subgrantees, and sub-subgrantees that directly operate Learn and Serve America supported service-learning programs and/or service-learning training and technical assistance activities. Respondents will be directed to the relevant sections of the Program Reporting Form based on their responses to the Grant Profile section.


The questions on this form refer to the July 1, 2010 – June 30, 2011 program year.











The Paperwork Reduction Act Statement

Public Burden Statement: The Paperwork Reduction Act of 1995 requires the Corporation to inform all potential persons who are to respond to this collection of information that such persons are not required to respond unless it displays a currently valid OMB control number (See 5 CFR 1320.5(b)(2)(i).

Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Corporation for National and Community Service, 1201 New York Avenue, NW, Washington, D.C. 20525; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503.


Privacy Act Statement

AUTHORITY: In accordance with the Privacy Act of 1974 (5 U.S.C § 552a) the following information is provided.

PURPOSE: The primary purpose of the user account is to provide a means for the Corporation for National and Community Service to collect and report on the activities of Learn and Serve America funded-programs. The collection of this information is authorized by the National and Community Service Act, as amended by the National and Community Service Trust Act of 1993.


ROUTINE USES: These routine purposes may include disclosure of the information to federal, state, or local agencies pursuant to lawfully authorized requests.

  • All information collected will be made available to the Corporation, any intermediary grantor of your Learn and Serve funds, if applicable, and federal, state, or local agencies pursuant to lawfully authorized requests;

  • Used as a basis for summaries, briefings, or responses to Members of Congress or other agencies in the Executive Branch of the Federal Government;

  • Provided to Congress or other Federal, State, and local agencies, when determined necessary.


MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING INFORMATION:


All non-personally identifiable information may be provided to the public. Personally identifiable information will not be provided to any other organizations without your prior written permission.

Additionally, disclosure of LASSIE data through the Open Government Initiative will be available to the public.


ACKNOWLEDGMENT:

I understand the provisions of the Privacy Act of 1974 as related to me through the foregoing statement.

CONTENT


I.Grant Profile

3



II.Program Performance Report

5



A.Program Participants and Activities

5



1.K-12 Individual School Version

6



2.K-12 Multiple Schools Version

15



3.Higher Education Version

24



4.Community-Based Version

33



B.Institutional Supports for Service-Learning

41



1.Individual School

42



2.School District

47



3.Higher Education Institution

52



4.Community-Based Organization

57



C.Training and Technical Assistance

61

I. Grant Profile


Organization

Grant ID number: PREASSIGNED

Organization/School Name:

Organization/School Nickname:

Grant Amount: PROVIDED BY GRANTING INSTITUTION


Organization Location

School District (if applicable):

Website (if any):

Street Address 1:

Street Address 2:

City:

State:

Zip plus four:


Contacts (You may enter additional contacts as needed)

Primary Contact Person:

Prefix:

First Name:

Last Name:

Title:

Email:

Telephone:

Fax:


  1. Select the organizational type that best describes your organization.

K-12 District

Higher Education

Community-Based Organization

School District

2 Year Public College

National Nonprofit
Organization

Regional Education Agency

2 Year Private College

State or Regional Nonprofit

State Education Agency

4 Year Public College or University

Local Nonprofit

K-12 School

4 Year Private College or University

State Service Commission

Public School

Graduate/Professional Program


Private School

Higher Education Association


Public Charter School


Indian/Tribal School



1a. If you are a higher education institution, please indicate if your college or university is a: (Definitions of the following institution types can be found in the US Department of Education’s Higher Education Act)

Historically Black College/ University

Native-American Serving (Non-Tribal) Institution

Alaska Native Serving Institution

Predominately Black Institution

Tribally Controlled College/University

Asian American and Pacific Islander Serving Institution

Hispanic Serving Institution

Native Hawaiian Serving Institution

Predominately Minority Population Community College


  1. Is your organization religious or faith-based?


Yes No Don’t Know


  1. Please indicate which of the following activities you performed during the 2010-2011 program year using Learn and Serve America grant funds:

My institution or organization ran Learn and Serve America supported service-learning activities. (Note: Answering yes to this question indicates that you will report on participants and service-learning activities for this program year.) [Positive respondents are directed to complete questions under Program Participants and Activities and Institutional Supports for Service-Learning sections of the Program Reporting Form.]

Yes

No

My institution or organization used Learn and Serve America funds to provide (directly or through a third party) training and technical assistance for service-learning activities. [Positive respondents are directed to complete questions under Training and Technical Activities Section of the Program Reporting Form.]

Yes

No

My institution or organization subgranted Learn and Serve America funds to other institutions or organizations. [Positive respondents are directed to complete question 5 of the Grant Profile.]

Yes

No


  1. Would you like to enable E-Worksheets? The E-Worksheets function is an optional tool for administrators and facilitators to maintain electronic records for certain collected data elements of the survey (e.g. participant counts and demographics). E-Worksheets can be sent to service-learning providers to record details on the service-learning activities. Data collected from E-Worksheets can be reviewed and automatically imported into your survey. For more information on the E-Worksheets, visit the LASSIE on-line help page.


Yes No


  1. If you provided subgrants, please list all of the institutions or organizations to which you make grants of Learn and Serve America funds. For each, please provide the name of the organization, the size of the grant, and contact information for the lead contact person for the programs. Please note, do not include mini-grants or grants to individuals within your institution, or small grants to individuals (for example, training stipends) in other institutions.


Institution/ Organization

Grant Size (Dollars)

Address

Contact Person

Telephone/ Fax

Email
































End of Grant Profile Questions


II. Program Reporting Form


A. Program Participants and Activities

There are four versions of this section of the survey. Respondents are directed to respond to the appropriate version based on the type of Learn and Serve America grant funds they received. Those who received K-12 School-Based grant funds and operate service-learning in a single school are directed to complete the K-12 Individual School form; those who received K-12 School-Based funds and operate service-learning in multiple schools are directed to complete the K-12 Multiple Schools form; those who received Higher Education grant funds are directed to complete the Higher Education form; and those who received Innovative and Community-Based grant funds (with the exception of special initiatives, such as Summer of Service and Youth Engagement Zones) are directed to complete the Community-Based form. NOTE: Recipients of special initiatives under Innovative and Community-Based grant funds are directed to complete distinct surveys. The on-line reporting system automatically identifies the appropriate form type based on the respondents’ grant numbers.


II-A: K-12 Individual School Version


  1. Are you reporting on Learn and Serve America supported service-learning activities in an individual school or multiple schools? [This is a screening question to determine which version of the K-12 Formula survey the respondent completes.]


Individual School Multiple Schools


I. Organizational Questions


  1. What grade levels are included in the school? Lowest grade _____ Highest grade _____


  1. What percentage of students in the school qualifies for free or reduced price lunch? _______%


  1. Institution size: provide the total number of students in the school.


Total Number of Students



  1. Approximately what percentage of students in the school were engaged in service-learning activities during the 2010-2011 academic year. Include all service-learning activities whether or not they were supported by Learn and Serve America grant funds.


Less than 10%

10-49%

50-89%

90-99%

100%

Don’t Know


  1. Approximately what percentage of service-learning activities occurs during the following periods? Note: Percentages should add to 100%.


Percent

Don’t Know

In-school time


Extracurricular programs


After-school programs






II. Service-Learning Participants

In this section we are interested in the individuals who have participated in Learn and Serve America supported service-learning programs and activities.


  1. P

    Note: For the purpose of this survey, a service-learner is a student, between the ages of 5 and 17, who participates in service-learning programs or activities that engage him or her in learning activities, assessment and reflection, and direct or indirect service to beneficiaries. Service-learning programs and activities include preparation and reflection, as well as direct service. Youth or adults engaged in one-time volunteer activities, as well as beneficiaries of the service-learning activities, should not be counted as service-learners.

    lease provide demographic information on the service-learners who were engaged in Learn and Serve America supported activities from July 1, 2010 to June 30, 2011. If you have no students in a given category, enter “0” in the relevant box.



Learn and Serve America Supported Service-Learners


Estimated Number of Service-Learners

Total number of individual service-learners in Learn and Serve America supported activities/programs



Grade Level of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

K - 5th grade


6th grade – 8th grade


9th grade – 12th grade


School Dropouts


Grade Unknown



Ethnic Background of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

Hispanic


Non-Hispanic


Ethnicity Unknown



Racial Background of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

American Indian or Alaska Native


Asian


Black or African American


Native Hawaiian or Other Pacific Islander


White


Two or More Races


Race Unknown



Gender of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

Male


Female


Gender Unknown




Learn and Serve America Service-Learners with Disabilities

Estimated Number of Service-Learners

Service-learners with disabilities



Learn and Serve America Service-Learners Serving in Summer Service-Learning Programs

Estimated Number of Service-Learners

Do Not Have Summer Programs

Service-learners serving in summer programs



Teacher and Staff Participation in Service-Learning

III.How many teachers and staff were involved in teaching, leading, and operating Learn and Serve America supported service-learning programs in the school this year? Count each teacher and staff, regardless of part-time or full-time status.


_______ Total number of teachers and staff



Additional volunteers

  1. Approximately how many K-12 youth volunteers (defined as youth 5-17 years old) were involved in Learn and Serve America supported service activities (i.e. one-time volunteers or volunteers recruited for service-learning activities). Do not include regular service-learners reported above.


_______ Estimated number of youth volunteers Don’t Know


  1. Approximately how many adult volunteers (defined as 18 or older) were involved in Learn and Serve America supported service-related activities (i.e. one-time volunteers or volunteers recruited for service-learning activities). Do not include staff and teachers reported above.


_______ Estimated number of adult volunteers Don’t Know


10a. Approximately how many of these adult volunteers are 55 years or older?

_______ Estimated number of adult volunteers 55 and older Don’t Know



III. Beneficiaries


IV.How many youth from disadvantaged circumstances received services through the Learn and Serve America supported service-learning activities during the 2010-2011 program year? Youth from disadvantaged circumstances are defined as those youth who are economically disadvantaged and one or more of the following: (a)are out-of-school, including out-of-school youth who are unemployed; (b) are in or aging out of foster care; (c) have limited English proficiency; (d) are homeless or have run away from home; (e) are at-risk to leave secondary school without a diploma; (f) are former juvenile offenders or at risk of delinquency; (g) are individuals with disabilities.


______ Estimated Number Don’t Know


  1. Approximately how many youth (ages 5-17) were mentored through the Learn and Serve America supported service-learning activities?


_____ Estimated Number Don’t Know Do not have mentoring activities (skip to question 13)


12a. Approximately how many of those mentored are from disadvantaged circumstances (see definition above)?


______ Estimated Number Don’t Know


  1. Approximately how many youth (ages 5-17) were tutored through the Learn and Serve America supported service-learning activities?


_____ Estimated Number Don’t Know Do not have tutoring activities (skip to question 14)


13a. Approximately how many of those tutored are from disadvantaged circumstances (see definition above)?


______ Estimated Number Don’t Know

IV. Program Duration and Service-Learning Characteristics


  1. This question is designed to gather information on the duration of Learn and Serve America service-learning activities in the school and the amount of time students are engaged in preparation, reflection, and service. Please fill in the table below with the numbers of service-learners and average hours of preparation and service. If you do not run projects for any of the three durations, check “Do Not Run.” If you don’t know the number of service-learners and average hours for any of the three durations, check “Don’t Know.”


Instructions for completing table on service hours

1. First, estimate the number of service-learners who were in service-learning programs of the durations listed in the table below from July 1, 2010 to June 30, 2011. If you have more than one activity or program in a given duration, please combine them in reporting participant numbers and hours. The total number of service-learners reported for this question may not equal the total number of service-learners reported in question 7 if individuals participated in more than one service-learning activity.

2. Next, for each of the project durations, calculate the average hours of preparation for the service and formal reflection per service-learner during or after the service and enter that figure in column 3.

3. Finally, enter the average number of hours of service for a service-learner. Enter that figure in column 4.


Preparation activities might include conducting background research, collecting data, attending trainings, assembling materials, rehearsing parts, and meeting to plan project activities during and after class.

Formal reflection activities might include classroom discussions, keeping a journal, writing an essay or a poem, and making a class presentation.

Service might include a variety of activities, including the following: providing direct service to individuals (tutoring, assisting at a human services agency, working in a classroom, etc.); service projects addressing a community need (for example, cleaning a park, raising money for a local program, monitoring local water quality), or educational efforts such as presenting a play on a community issue, organizing or testifying at a public hearing, or preparing educational materials (brochures, posters, etc.) on a local issue.


Example 1. The “Plant a Tree Project” lasted 2 months and involved 60 students (see ‘a’ in the table below). The average student in this project spent 8 hours engaged in preparation for the service and in formal reflection activities during and after the service (see ‘b’). The service activity itself took approximately 2 hours per student (see ‘c’).


Example 2: The senior Civics Class is organized around a core service-learning program. It meets one hour, two days a week for one semester, and has 25 students (see ‘d’). Each student in this class spent 63 hours engaged in service-learning preparation for the service and formal reflection during and after the service (see ‘e’). The service activity itself was 10 hours (see ‘f’). (Calculation: 2 hours of class + 1 hour of preparation + .5 hours of formal reflection x 18 weeks = 63 hours per student; 10 hours of service per student).



EXAMPLES

Duration

Do Not Run This Type of Program

Number of Service-Learners

Average Hours of Preparation and/or Formal Reflection per Service-Learner

Average Hours of Service per Service-Learner

Do Not Know

Programs and activities that last 2 months or less


a. 60 students

b. 8 hours each

c. 2 hours each


Programs and activities that last for most or all of one semester or term



d. 25 students


e. 63 hours each


f. 10 hours each


Programs and activities that last for most or all of the whole school year






[End of pop-up instruction page]




PLEASE FILL IN

Duration

Do Not Run This Type of Program

Number of Service-Learners

Average Hours of Preparation and/or Formal Reflection per Service-Learner

Average Hours of Service per Service-Learner

Do Not Know*

Programs and activities that last approximately 2 months or less






Programs and activities that last for most or all of one semester or term






Programs and activities that last for most or all of the whole school year






* If DO NOT KNOW – instruction will pop up: “If you do not know, please estimate the number of hours you expect someone to spend.”


V. Project Characteristics


  1. How frequently do the Learn and Serve America supported service-learning activities in the school include the following characteristics?


Never

(0%)

Less than 50% of the time

More than 50% of the time

Always

(100%)

N/A

  1. Service-learners participate in a community needs assessment to plan the service-learning project


  1. The service-learning activities are of a sustained and significant duration (i.e. concentrated blocks of time over a period of several months)


  1. The learning objectives for the service-learning activities are aligned with the academic curriculum

  1. The service-learning activities are included in student records

  1. Community partners collaborate in setting goals and establishing an action plan


  1. Service-learners generate ideas and make decisions on the design and implementation of the service-learning project


  1. Service-learners present their findings from the service-learning project to community members


  1. Service-learners engage with diverse perspectives through the service-learning project


  1. Service-learners examine the broader social and civic context for the identified community need


  1. The project includes a variety of reflection activities that examine changes in service-learners’ knowledge and attitudes


  1. Service-learners measure their progress toward meeting specific service goals and learning outcomes during the project


  1. The service activities present opportunities for the participants to apply newly acquired skills and knowledge to a community need



VI. Community Needs and Service Activities


Issue Areas and Community Needs

  1. This question is designed to gather information on the types of community needs that the Learn and Serve America supported service-learning activities have been designed to address. The community needs have been categorized into ten general issue areas. For each issue area, provide the percentage of the service-learning activities that address the relevant issue area. If there are no service activities that address a given area, leave the % field blank (do not enter “0”). For each area with activities, check up to three of the most common types of community needs being addressed by the activities.



Community Development ____ % of service activities

Civic/Public Infrastructure

Homeless Assistance

Transportation

Community Clean-up

Social Services Planning/Delivery

Volunteer Capacity/Management

Historic Preservation

Animal Care Services

Independent Living Assistance



Other Community Development (specify)


Economic Development ____ % of service activities

Financial Literacy

Workforce Development

Financial Asset Development

Economic Revitalization

Technology Access

Other Economic Development (specify)


Disaster Recovery and Relief ____ % of service activities

Disaster Mitigation

Disaster Recovery

Other Disaster (specify)

Disaster Preparedness

Disaster Relief




Education ____ % of service activities

Adult Literacy

Computer Literacy

Special Education Programs

After School Programs

English Language Learning

Classroom Education

Child Literacy

Job Preparedness

Cultural Heritage


School Preparedness

Other Education (specify)


Environment and Energy ____ % of service activities

Clean Air

Environmental Protection

Waste Reduction/Recycling

Clean Water

Environmental Restoration

Weatherization

Energy Conservation

Indoor Environment

Environmental Awareness



Other Environment (specify)


Health & Wellness/Nutrition _____ % of service activities

Disabilities Services

HIV/AIDS Prevention

Nutrition Education

Food Distribution/Collection

Health & Wellness Education

Substance Abuse Prevention/Rehabilitation

Food Production

Maternal/Child Health Services

Aid to Seniors/Elders

Health Service Delivery

Mental Health Services

Other Health/Nutrition (specify)


Public Safety ____ % of service activities

Accident Prevention

Crisis Intervention

Victim/Witness Services

Community Policing

Fire Prevention

Public Safety Education

Conflict Resolution/Mediation

Legal Assistance

Crime Awareness/Prevention

Offender/Ex-Offender Services/Rehabilitation

Children and Youth Safety

Other Public Safety (specify)


Youth Development ____ % of service activities

Children and Youth Safety

Juvenile Justice Services

Bullying Prevention

Delinquency Prevention

Teen Pregnancy/Parenting Services

Other Youth Development (specify)

Gang Prevention/Rehabilitation

Youth Leadership Development



Veterans Assistance ____ % of service activities

Housing Assistance

Military Family Assistance

Veteran Employment Services

Outreach and Counseling

Veteran Disabilities/ Rehabilitation Assistance

Other Veterans (specify)



Service Activities

  1. (For the most common issue area, or the issue area with the highest percentage of activities in question 16) Please provide a brief description (200 word limit) the specific service-learning activities that were used in addressing the community need. In the description, include the goals of the project, the participants and beneficiaries involved, the location of the service-learning activities, and any measured outcomes.

(Note: You only need to provide activities for the most common community need. If desired, you may select a different community need or provide a description of service activities for more than one community need.)




II-A: K-12 Multiple Schools Version


  1. Are you reporting on Learn and Serve America supported service-learning activities in an individual school or multiple schools? [This is a screening question to determine which version of the K-12 Formula survey the respondent completes.]


Individual School Multiple Schools


I. Organizational Questions

When answering the following questions, include all of the schools that had Learn and Serve America supported service-learning activities.


  1. In how many schools are the Learn and Serve America supported service-learning activities taking place during the 2010-2011 program year?


_____ Elementary schools _____ Middle schools _____ Secondary schools


  1. What grade levels are included in the schools with Learn and Serve America supported service-learning activities?


Lowest grade _____ Highest grade _____


  1. On average, what percentage of students in the schools is qualified for free or reduced price lunch?


_______%


  1. Institution size: provide the total number of students in all of the schools with Learn and Serve America supported service-learning activities.


Total Number of Students



  1. Approximately what percentage of students in the schools were engaged in service-learning activities during the 2010-2011 academic year. Include all service-learning activities whether or not they were supported by Learn and Serve America grant funds.


Less than 10%

10-49%

50-89%

90-99%

100%

Don’t Know


  1. Approximately what percentage of service-learning activities in the schools occurs during the following periods? Note: Percentages should add to 100%.


Percent

Don’t Know

In-school time


Extracurricular programs


After-school programs






II. Service-Learning Participants

In this section we are interested in the individuals who participate in Learn and Serve America service-learning programs and activities.


  1. P

    Note: For the purpose of this survey, a service-learner is a student, between the ages of 5 and 17, who participates in service-learning programs or activities that engage him or her in learning activities, assessment and reflection, and direct or indirect service to beneficiaries. Service-learning programs and activities include preparation and reflection, as well as direct service. Youth or adults engaged in one-time volunteer activities, as well as beneficiaries of the service-learning activities, should not be counted as service-learners.

    lease provide demographic information on the service-learners who were engaged in Learn and Serve America supported activities from July 1, 2010 to June 30, 2011. If you have no students in a given category, enter “0” in the relevant box.



Learn and Serve America supported Service-Learners

Estimated Number of Service-Learners

Total number of individual service-learners in Learn and Serve America supported activities/programs



Grade Level of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

K - 5th grade


6th grade – 8th grade


9th grade – 12th grade


School dropouts


Grade unknown



Ethnic Background of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

Hispanic


Non-Hispanic


Ethnicity Unknown



Racial Background of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

American Indian or Alaska Native


Asian


Black or African American


Native Hawaiian or Other Pacific Islander


White


Two or more races


Race Unknown



Gender of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

Male


Female


Gender Unknown




Learn and Serve America Service-Learners with Disabilities

Estimated Number of Service-Learners

Service-learners with disabilities




Learn and Serve America Service-Learners Serving in Summer Service-Learning Programs

Estimated Number of Service-Learners

Do Not Have Summer Programs

Service-learners serving in summer programs



Teacher/Staff Participation in Service-Learning

V.How many teachers and staff were involved in teaching, leading, and operating Learn and Serve America supported service-learning programs in the schools this year? Count each teacher and staff, regardless of part-time or full-time status.


_______ Total number of teachers and staff



Additional volunteers

  1. Approximately how many K-12 youth volunteers (defined as youth 5-17 years old) were involved in Learn and Serve America supported service activities (i.e. one-time volunteers or volunteers recruited for service-learning activities). Do not include regular service-learners reported above.


_______ Estimated number of youth volunteers Don’t Know


  1. Approximately how many adult volunteers (defined as 18 or older) were involved in Learn and Serve America supported service-related activities (i.e. one-time volunteers or volunteers recruited for service-learning activities). Do not include staff and teachers reported above.


_______ Estimated number of adult volunteers Don’t Know


11a. Approximately how many of these adult volunteers are 55 years or older?

_______ Estimated number of adult volunteers 55 and older Don’t Know



III. Beneficiaries


VI.How many youth from disadvantaged circumstances received services through the Learn and Serve America supported service-learning activities during the 2010-2011 program year? Youth from disadvantaged circumstances are defined as those youth who are economically disadvantaged and one or more of the following: (a)are out-of-school, including out-of-school youth who are unemployed; (b) are in or aging out of foster care; (c) have limited English proficiency; (d) are homeless or have run away from home; (e) are at-risk to leave secondary school without a diploma; (f) are former juvenile offenders or at risk of delinquency; (g) are individuals with disabilities.


______ Estimated Number Don’t Know


  1. Approximately how many youth (ages 5-17) were mentored through your Learn and Serve America supported service-learning activities?


_____ Estimated Number Don’t Know Do not have mentoring activities (skip to question 14)


13a. Approximately how many of those mentored are from disadvantaged circumstances (see definition above)?


______ Estimated Number Don’t Know


  1. Approximately how many youth (ages 5-17) were tutored through your Learn and Serve America supported service-learning activities?


_____ Estimated Number Don’t Know Do not have tutoring activities (skip to question 15)


14a. Approximately how many of those tutored are from disadvantaged circumstances (see definition above)?


______ Estimated Number Don’t Know

IV. Program Duration and Service-Learning Characteristics


  1. This question is designed to gather information on the duration of Learn and Serve America service-learning activities in the schools and the amount of time students are engaged in preparation, reflection, and service. Please fill in the table below with the numbers of service-learners and average hours of preparation and service. If you do not run projects for any of the three durations, check “Do Not Run.” If you don’t know the number of service-learners and average hours for any of the three durations, check “Don’t Know.”


Instructions for completing table on service hours

1. First, estimate the number of service-learners who were in service-learning programs of the durations listed in the table below from July 1, 2010 to June 30, 2011. If you have more than one activity or program in a given duration, please combine them in reporting participant numbers and hours. The total number of participants reported for this question may not equal the total number of participants reported in question 8 if individuals participated in more than one service-learning activity.

2. Next, for each of the project durations, calculate the average hours of preparation for the service and formal reflection per service-learner during or after the service and enter that figure in column 3.

3. Finally, enter the average number of hours of service for a service-learner. Enter that figure in column 4.


Preparation activities might include conducting background research, collecting data, attending trainings, assembling materials, rehearsing parts, and meeting to plan project activities during and after class.

Formal reflection activities might include classroom discussions, keeping a journal, writing an essay or a poem, and making a class presentation.

Service might include a variety of activities, including the following: providing direct service to individuals (tutoring, assisting at a human services agency, working in a classroom, etc.); service projects addressing a community need (for example, cleaning a park, raising money for a local program, monitoring local water quality), or educational efforts such as presenting a play on a community issue, organizing or testifying at a public hearing, or preparing educational materials (brochures, posters, etc.) on a local issue.


Example 1. The “Plant a Tree Project” lasted 2 months and involved 60 students (see ‘a’ in the table below). The average student in this project spent 8 hours engaged in preparation for the service and in formal reflection activities during and after the service (see ‘b’). The service activity itself took approximately 2 hours per student (see ‘c’).


Example 2: The senior Civics Class is organized around a core service-learning program. It meets one hour, two days a week for one semester, and has 25 students (see ‘d’). Each student in this class spent 63 hours engaged in service-learning preparation for the service and formal reflection during and after the service (see ‘e’). The service activity itself was 10 hours (see ‘f’). (Calculation: 2 hours of class + 1 hour of preparation + .5 hours of formal reflection x 18 weeks = 63 hours per student; 10 hours of service per student).



EXAMPLES

Duration

Do Not Run This Type of Program

Number of Service-Learners

Average Hours of Preparation and/or Formal Reflection per Participant

Average Hours of Service per Participant

Do Not Know

Programs and activities that last 2 months or less


a. 60 participants

b. 8 hours each

c. 2 hours each


Programs and activities that last for most or all of one semester or term



d. 25 students


e. 63 hours each


f. 10 hours each


Programs and activities that last for most or all of the whole school year










PLEASE FILL IN

Duration

Do Not Run This Type of Program

Number of Participants

Average Hours of Preparation and/or Formal Reflection per Participant

Average Hours of Service per Participant

Do Not Know

Programs and activities that last approximately 2 months or less






Programs and activities that last for most or all of one semester or term






Programs and activities that last for most or all of the whole school year






* If DO NOT KNOW – instruction will pop up: “If you do not know, please estimate the number of hours you expect someone to spend.”


V. Project Characteristics


  1. How frequently do the Learn and Serve America supported service-learning activities in the schools include the following characteristics?


Never

(0%)

Less than 50% of the time

More than 50% of the time

Always

(100%)

N/A

  1. Service-learners participate in a community needs assessment to plan the service-learning project

  1. The service-learning activities are of a sustained and significant duration (i.e. concentrated blocks of time over a period of several months)

  1. The learning objectives for the service-learning activities are aligned with the academic curriculum

  1. The service-learning activities are included in student records

  1. Community partners collaborate in setting goals and establishing an action plan

  1. Service-learners generate ideas and make decisions on the design and implementation of the service-learning project

  1. Service-learners present their findings from the service-learning project to community members

  1. Service-learners engage with diverse perspectives through the service-learning project

  1. Service-learners examine the broader social and civic context for the identified community need

  1. The project includes a variety of reflection activities that examine changes in service-learners’ knowledge and attitudes

  1. Service-learners measure their progress toward meeting specific service goals and learning outcomes during the project

  1. The service activities present opportunities for the participants to apply newly acquired skills and knowledge to a community need

VI. Community Needs and Service Activities


Issue Areas and Community Needs


  1. This question is designed to gather information on the types of community needs that the Learn and Serve America supported service-learning activities have been designed to address. The community needs have been categorized into ten general issue areas. For each issue area, provide the percentage of the service-learning activities that address the relevant issue area. If there are no service activities that address a given area, leave the % field blank (do not enter “0”). For each area with activities, check up to three of the most common types of community needs being addressed by the activities.


Community Development ____ % of service activities

Civic/Public Infrastructure

Homeless Assistance

Transportation

Community Clean-up

Social Services Planning/Delivery

Volunteer Capacity/Management

Historic Preservation

Animal Care Services

Independent Living Assistance



Other Community Development (specify)


Economic Development ____ % of service activities

Financial Literacy

Workforce Development

Financial Asset Development

Economic Revitalization

Technology Access

Other Economic Development (specify)


Disaster Recovery and Relief ____ % of service activities

Disaster Mitigation

Disaster Recovery

Other Disaster (specify)

Disaster Preparedness

Disaster Relief




Education ____ % of service activities

Adult Literacy

Computer Literacy

Special Education Programs

After School Programs

English Language Learning

Classroom Education

Child Literacy

Job Preparedness

Cultural Heritage


School Preparedness

Other Education (specify)


Environment and Energy ____ % of service activities

Clean Air

Environmental Protection

Waste Reduction/Recycling

Clean Water

Environmental Restoration

Weatherization

Energy Conservation

Indoor Environment

Environmental Awareness



Other Environment (specify)


Health & Wellness/Nutrition _____ % of service activities

Disabilities Services

HIV/AIDS Prevention

Nutrition Education

Food Distribution/Collection

Health & Wellness Education

Substance Abuse Prevention/Rehabilitation

Food Production

Maternal/Child Health Services

Aid to Seniors/Elders

Health Service Delivery

Mental Health Services

Other Health/Nutrition (specify)


Public Safety ____ % of service activities

Accident Prevention

Crisis Intervention

Victim/Witness Services

Community Policing

Fire Prevention

Public Safety Education

Conflict Resolution/Mediation

Legal Assistance

Crime Awareness/Prevention

Offender/Ex-Offender Services/Rehabilitation

Children and Youth Safety

Other Public Safety (specify)


Youth Development ____ % of service activities

Children and Youth Safety

Juvenile Justice Services

Bullying Prevention

Delinquency Prevention

Teen Pregnancy/Parenting Services

Other Youth Development (specify)

Gang Prevention/Rehabilitation

Youth Leadership Development



Veterans Assistance ____ % of service activities

Housing Assistance

Military Family Assistance

Veteran Employment Services

Outreach and Counseling

Veteran Disabilities/ Rehabilitation Assistance

Other Veterans (specify)


Service Activities

  1. (For the most common issue area, or the issue area with the highest percentage of activities in question 17) Please provide a brief description (200 word limit) the specific service-learning activities that were used in addressing the community need. In the description, include the goals of the project, the participants and beneficiaries involved, the location of the service-learning activities, and any measured outcomes.

(Note: You only need to provide activities for the most common community need. If desired, you may select a different community need or provide a description of service activities for more than one community need.)


II-A: Higher Education Version


I. Organizational Questions


  1. Institution size: provide the total number of students in the higher education institution.


Total Number of Students



  1. Approximately what percentage of students in the higher education institution was engaged in service-learning activities during the 2010-2011 academic year. Include all service-learning activities whether or not they were supported by Learn and Serve America grant funds.


Less than 10%

10-49%

50-89%

90-99%

100%

Don’t Know


  1. Approximately what percentage of service-learning activities occurs during the following periods? Note: Percentages should add to 100%.


Percent

Don’t Know

Curricular courses


Co-curricular/Extracurricular programs


Noncurricular academic activities






II. Service-Learning Participants

In this section we are interested in the individuals who participate in your Learn and Serve America supported service-learning programs and activities.


  1. Please provide demographic information on the service-learners who were engaged in Learn and Serve America supported activities from July 1, 2010 to June 30, 2011. If you have no students in a given category, enter “0” in the relevant box.


Frame4


Learn and Serve America Supported Service-Learners

Estimated Number of Service-Learners

Total number of higher education student service-learners in Learn and Serve America supported activities/programs



Undergraduate student service-learners



Graduate student service-learners



Unknown


Total number of non-higher education student service-learners in Learn and Serve America supported activities/programs



K – 5th grade



6th grade – 8th grade



9th grade – 12th grade



School dropouts



Grade unknown



Ethnic Background of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

Hispanic


Non-Hispanic


Ethnicity Unknown



Racial Background of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

American Indian or Alaska Native


Asian


Black or African American


Native Hawaiian or Other Pacific Islander


White


Two or more races


Race Unknown



Gender of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

Male


Female


Gender Unknown



Learn and Serve America Service-Learners with Disabilities

Estimated Number of Service-Learners

Service-learners with disabilities



Learn and Serve America Service-Learners Serving in Summer Service-Learning Programs

Estimated Number of Service-Learners

Do Not Have Summer Programs

Service-learners serving in summer programs



Faculty and Staff Participation in Service-Learning

VII.How many faculty and staff were involved in Learn and Serve America-funded service-learning activities in the higher education institution this year? Include faculty and staff who taught service-learning courses, participated in service-learning curriculum development, or otherwise assisted in the development and/or implementation of service-learning activities. Count each faculty and staff member, regardless of part-time or full-time status.


_______ Total number of faculty and staff


Adult Community Members

  1. How many adult community members participated in Learn and Serve America supported service-learning activities? Community members include those involved in the planning and implementation of service-learning activities, such as staff from partner organizations. Do not include one-time volunteers or volunteers recruited for service-learning activities.


_______ Total number of faculty and staff


Additional Volunteers

  1. Approximately how many youth volunteers (defined as youth 5-17 years old) were involved in Learn and Serve America supported service activities (one-time volunteers). Do not include service-learners reported above.


________ Estimated number of youth volunteers Don’t Know


  1. Approximately how many adult volunteers (defined as 18 or older) were involved in Learn and Serve America supported service-related activities (one-time volunteers). Do not include participants reported above.


________ Estimated number of adult volunteers Don’t Know


8a. Approximately how many of these adult volunteers are 55 years or older?

_______ Estimated number of adult volunteers 55 and older Don’t Know








III. Beneficiaries


VIII.How many youth from disadvantaged circumstances received services through the Learn and Serve America supported service-learning activities during the 2010-2011 program year? Youth from disadvantaged circumstances are defined as those youth who are economically disadvantaged and one or more of the following: (a)are out-of-school, including out-of-school youth who are unemployed; (b) are in or aging out of foster care; (c) have limited English proficiency; (d) are homeless or have run away from home; (e) are at-risk to leave secondary school without a diploma; (f) are former juvenile offenders or at risk of delinquency; (g) are individuals with disabilities.


______ Estimated Number Don’t Know


  1. Approximately how many youth (ages 5-17) were mentored through your Learn and Serve America supported service-learning activities?


_____ Estimated Number Don’t Know Do not have mentoring activities (skip to question 11)


10a. Approximately how many of those mentored are from disadvantaged circumstances (see definition above)?


______ Estimated Number Don’t Know


  1. Approximately how many youth (ages 5-17) were tutored through your Learn and Serve America supported service-learning activities?


_____ Estimated Number Don’t Know Do not have tutoring activities (skip to question 12)


11a. Approximately how many of those tutored are from disadvantaged circumstances (see definition above)?


______ Estimated Number Don’t Know





IV. Program Duration and Service-Learning Characteristics


  1. This question is designed to gather information on the duration of Learn and Serve America service-learning activities in the school and the amount of time students are engaged in preparation, reflection, and service. Please fill in the table below with the numbers of service-learners and average hours of preparation and service. If you do not run projects for any of the three durations, check “Do Not Run.” If you don’t know the number of service-learners and average hours for any of the three durations, check “Don’t Know.”


Instructions for completing table on service hours

1. First, estimate the number of service-learners who were in service-learning programs of the durations listed in the table below from July 1, 2010 to June 30, 2011. If you have more than one activity or program in a given duration, please combine them in reporting participant numbers and hours. The total number of service-learners reported for this question may not equal the total number of service-learners reported in question 4 if individuals participated in more than one service-learning activity.


2. Next, for each of the project durations, calculate the average hours of preparation for the service and formal reflection per service-learner during or after the service and enter that figure in column 3.

3. Finally, enter the average number of hours of service for a service-learner. Enter that figure in column 4.


Preparation activities might include conducting background research, collecting data, attending trainings, assembling materials, rehearsing parts, and meeting to plan project activities during and after class.

Formal reflection activities might include classroom discussions, keeping a journal, writing an essay or a poem, and making a class presentation.

Service might include a variety of activities, including the following: providing direct service to individuals (tutoring, assisting at a human services agency, working in a classroom, etc.); service projects addressing a community need (for example, cleaning a park, raising money for a local program, monitoring local water quality), or educational efforts such as presenting a play on a community issue, organizing or testifying at a public hearing, or preparing educational materials (brochures, posters, etc.) on a local issue.


Example 1. The “Plant a Tree Project” lasted 2 months and involved 60 students (see ‘a’ in the table below). The average student in this project spent 8 hours engaged in preparation for the service and in formal reflection activities during and after the service (see ‘b’). The service activity itself took approximately 2 hours per student (see ‘c’).


Example 2: The senior Civics Class is organized around a core service-learning program. It meets one hour, two days a week for one semester, and has 25 students (see ‘d’). Each student in this class spent 63 hours engaged in service-learning preparation for the service and formal reflection during and after the service (see ‘e’). The service activity itself was 10 hours (see ‘f’). (Calculation: 2 hours of class + 1 hour of preparation + .5 hours of formal reflection x 18 weeks = 63 hours per student; 10 hours of service per student).



EXAMPLES

Duration

Do Not Run this Type of Program

Number of Service-Learners

Average Hours of Preparation and/or Formal Reflection per Service-Learner

Average Hours of Service per Service-Learner

Don’t Know

Programs and activities that last 2 months or less


a. 60 students

b. 8 hours each

c. 2 hours each


Programs and activities that last for most or all of one semester or term



d. 25 students


e. 63 hours each


f. 10 hours each


Programs and activities that last for most or all of the whole academic year






[End of pop-up instruction page]





PLEASE FILL IN

Duration

Do Not Run this Type of Program

Number of Service-Learners

Average Hours of Preparation and/or Formal Reflection per Service-Learner

Average Hours of Service per Service-Learner

Don’t Know

Programs and activities that last 2 months or less






Programs and activities that last for most or all of one semester or term






Programs and activities that last for most or all of the whole academic year






*If DO NOT KNOW – instruction will pop up: “If you do not know, please estimate the number of hours you expect someone to spend.”


V. Project Characteristics


  1. How frequently do the Learn and Serve America supported service-learning activities in the higher education institution include the following characteristics?


Never

(0%)

Less than 50% of the time

More than 50% of the time

Always

(100%)

N/A

  1. Service-learners participate in a community needs assessment to plan the service-learning project

  1. The service-learning activities are of a sustained and significant duration (i.e. concentrated blocks of time over a period of several months)

  1. The learning objectives for the service-learning activities are aligned with the academic curriculum

  1. The service-learning activities are included in student records

  1. Community partners collaborate in setting goals and establishing an action plan

  1. Service-learners generate ideas and make decisions on the design and implementation of the service-learning project

  1. Service-learners present their findings from the service-learning project to community members

  1. Service-learners engage with diverse perspectives through the service-learning project

  1. Service-learners examine the broader social and civic context for the identified community need

  1. The project includes a variety of reflection activities that examine changes in service-learners’ knowledge and attitudes

  1. Service-learners measure their progress toward meeting specific service goals and learning outcomes during the project

  1. The service activities present opportunities for the participants to apply newly acquired skills and knowledge to a community need

VI. Community Needs and Service Activities



Issue Areas and Community Needs

  1. This question is designed to gather information on the community needs that the Learn and Serve America supported service-learning activities have been designed to address. The community needs have been categorized into ten general issue areas. For each issue area, provide the percentage of the service-learning activities that address the relevant issue area. If there are no service activities that address a given area, leave the % field blank (do not enter “0”). For each area with activities, check up to three of the most common types of community needs being addressed by the activities.



Community Development ____ % of service activities

Civic/Public Infrastructure

Homeless Assistance

Transportation

Community Clean-up

Social Services Planning/Delivery

Volunteer Capacity/Management

Historic Preservation

Animal Care Services

Independent Living Assistance



Other Community Development (specify)


Economic Development ____ % of service activities

Financial Literacy

Workforce Development

Financial Asset Development

Economic Revitalization

Technology Access

Other Economic Development (specify)


Disaster Recovery and Relief ____ % of service activities

Disaster Mitigation

Disaster Recovery

Other Disaster (specify)

Disaster Preparedness

Disaster Relief



Education ____ % of service activities

Adult Literacy

Computer Literacy

Special Education Programs

After School Programs

English Language Learning

Classroom Education

Child Literacy

Job Preparedness

Cultural Heritage


School Preparedness

Other Education (specify)


Environment and Energy ____ % of service activities

Clean Air

Environmental Protection

Waste Reduction/Recycling

Clean Water

Environmental Restoration

Weatherization

Energy Conservation

Indoor Environment

Environmental Awareness



Other Environment (specify)


Health & Wellness/Nutrition _____ % of service activities

Disabilities Services

HIV/AIDS Prevention

Nutrition Education

Food Distribution/Collection

Health & Wellness Education

Substance Abuse Prevention/Rehabilitation

Food Production

Maternal/Child Health Services

Aid to Seniors/Elders

Health Service Delivery

Mental Health Services

Other Health/Nutrition (specify)


Public Safety ____ % of service activities

Accident Prevention

Crisis Intervention

Victim/Witness Services

Community Policing

Fire Prevention

Public Safety Education

Conflict Resolution/Mediation

Legal Assistance

Crime Awareness/Prevention

Offender/Ex-Offender Services/Rehabilitation

Children and Youth Safety

Other Public Safety (specify)




Youth Development ____ % of service activities

Children and Youth Safety

Juvenile Justice Services

Bullying Prevention

Delinquency Prevention

Teen Pregnancy/Parenting Services

Other Youth Development (specify)

Gang Prevention/Rehabilitation

Youth Leadership Development



Veterans Assistance ____ % of service activities

Housing Assistance

Military Family Assistance

Veteran Employment Services

Outreach and Counseling

Veteran Disabilities/ Rehabilitation Assistance

Other Veterans (specify)



Service Activities

  1. (For the most common issue area, or the issue area with the highest percentage of activities in question 14) Please provide a brief description (200 word limit) the specific service-learning activities that were used in addressing the community need. In the description, include the goals of the project, the participants and beneficiaries involved, the location of the service-learning activities, and any measured outcomes.

(Note: You only need to provide activities for the most common community need. If desired, you may select a different community need or provide a description of service activities for more than one community need.)



II-A: Community-Based Version

I. Service-Learning Participants

In this section we are interested in the individuals who have participated in the Learn and Serve America supported service learning programs and activities.


  1. Please provide demographic information on the service-learners who were engaged in Learn and Serve America supported activities from July 1, 2010 to June 30, 2011. If you have no service-learners in a given category, enter “0” in the relevant box.


Frame5


Learn and Serve America Supported Service-Learners


Estimated Number of Service-Learners

Total number of individual service-learners in Learn and Serve America supported activities/programs



Grade Level of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

K – 5th grade


6th grade – 8th grade


9th grade – 12th grade


School dropouts


Grade unknown



Ethnic Background of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

Hispanic


Non-Hispanic


Ethnicity Unknown



Racial Background of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

American Indian or Alaska Native


Asian


Black or African American


Native Hawaiian or Other Pacific Islander


White


Two or more races


Race Unknown



Gender of Learn and Serve America Service-Learners

Estimated Number of Service-Learners

Male


Female


Gender Unknown



Learn and Serve America Service-Learners with Disabilities

Estimated Number of Service-Learners

Service-learners with disabilities



Learn and Serve America Service-Learners in Summer Service-Learning Programs

Estimated Number of Service-Learners

Do Not Have Summer Programs

Service-learners serving in summer programs



Teacher and Staff Participation in Service-Learning

IX.How many teachers and staff were involved in teaching, leading, and operating Learn and Serve America supported service-learning programs this year? Count each teacher and staff, regardless of part-time or full-time status.


_______ Total number of teachers and staff



Additional Volunteers

  1. Approximately how many youth volunteers (defined as youth 5-17 years old) were involved in Learn and Serve America supported service activities (i.e. one-time volunteers or volunteers recruited for service-learning activities). Do not include regular service-learners reported above.


________ Estimated number of youth volunteers Don’t Know


  1. Approximately how many adult volunteers (defined as 18 or older) were involved in Learn and Serve America supported service-related activities (i.e. one-time volunteers or volunteers recruited for service-learning activities). Do not include staff and teachers reported above.


________ Estimated number of adult volunteers Don’t Know


4a. Approximately how many of these adult volunteers are 55 years or older?

_______ Estimated number of adult volunteers 55 and older Don’t Know




II. Beneficiaries


X.How many youth from disadvantaged circumstances received services through the Learn and Serve America supported service-learning activities during the 2010-2011 program year? Youth from disadvantaged circumstances are defined as those youth who are economically disadvantaged and one or more of the following: (a)are out-of-school, including out-of-school youth who are unemployed; (b) are in or aging out of foster care; (c) have limited English proficiency; (d) are homeless or have run away from home; (e) are at-risk to leave secondary school without a diploma; (f) are former juvenile offenders or at risk of delinquency; (g) are individuals with disabilities.


______ Estimated Number Don’t Know


  1. Approximately how many youth (ages 5-17) were mentored through your Learn and Serve America supported service-learning activities?


_______ Estimated Number Don’t Know Do not have mentoring activities (skip to question 7)


6a. Approximately how many of those mentored are from disadvantaged circumstances (see definition above)?


_______ Estimated Number Don’t Know


  1. Approximately how many youth (ages 5-17) were tutored through your Learn and Serve America supported service-learning activities?


_______ Estimated Number Don’t Know Do not have tutoring activities (skip to question 8)


7a. Approximately how many of those tutored are from disadvantaged circumstances (see definition above)?


_______ Estimated Number Don’t Know




III. Program Duration and Service-Learning Characteristics


  1. This question is designed to gather information on the duration of Learn and Serve America service-learning activities and the amount of time youth are engaged in preparation, reflection, and service. Please fill in the table below with the numbers of service-learners and average hours of preparation and service. If you do not run projects for any of the three durations, check “Do Not Run.” If you don’t know the number of service-learners and average hours for any of the three durations, check “Don’t Know.”


Instructions for completing table on service hours

1. First, estimate the number of service-learners who were in service-learning programs of the durations listed in the table below from July 1, 2010 to June 30, 2011. If you have more than one activity or program in a given duration, please combine them in reporting participant numbers and hours. The total number of service-learners reported for this question may not equal the total number of service-learners reported in question 1 if individuals participated in more than one service-learning activity.


2. Next, for each of the project durations, calculate the average hours of preparation for the service and formal reflection per service-learner during or after the service and enter that figure in column 3.


3. Finally, enter the average number of hours of service for a service-learner. Enter that figure in column 4.


Preparation activities might include conducting background research, collecting data, attending trainings, assembling materials, rehearsing parts, and meeting to plan project activities during and after class.

Formal reflection activities might include classroom discussions, keeping a journal, writing an essay or a poem, and making a class presentation.

Service might include a variety of activities, including the following: providing direct service to individuals (tutoring, assisting at a human services agency, working in a classroom, etc.); service projects addressing a community need (for example, cleaning a park, raising money for a local program, monitoring local water quality), or educational efforts such as presenting a play on a community issue, organizing or testifying at a public hearing, or preparing educational materials (brochures, posters, etc.) on a local issue.


Example 1. The “Plant a Tree Project” lasted 2 months and involved 60 students (see ‘a’ in the table below). The average student in this project spent 8 hours engaged in preparation for the service and in formal reflection activities during and after the service (see ‘b’). The service activity itself took approximately 2 hours per student (see ‘c’).


Example 2: The senior Civics Class is organized around a core service-learning program. It meets one hour, two days a week for one semester, and has 25 students (see ‘d’). Each student in this class spent 63 hours engaged in service-learning preparation for the service and formal reflection during and after the service (see ‘e’). The service activity itself was 10 hours (see ‘f’). (Calculation: 2 hours of class + 1 hour of preparation + .5 hours of formal reflection x 18 weeks = 63 hours per student; 10 hours of service per student).



EXAMPLES

Duration

Do Not Run This Type of Program

Number of Service-Learners

Average Hours of Preparation and/or Formal Reflection per Service-Learner

Average Hours of Service per Service-Learner

Do Not Know

Programs and activities that last 2 months or less


a. 60 youth

b. 8 hours each

c. 2 hours each


Programs and activities that last for 3 to 6 months



d. 25 youth


e. 63 hours each


f. 10 hours each


Programs and activities that last for 7 months to one year






[End of pop-up instruction page]





PLEASE FILL IN

Duration

Do Not Run this Type of Program

Number of Service-Learners

Average Hours of Preparation and/or Formal Reflection per Service-Learner

Average Hours of Service per Service-Learner

Do Not Know*

Programs and activities that last 2 months or less






Programs and activities that last for 3 to 6 months






Programs and activities that last for 7 months to one year






* IF DO NOT KNOW – instruction will pop up: “If you do not know, please estimate the number of hours you expect someone to spend.”



IV. Project Characteristics


  1. How frequently do the Learn and Serve America supported service-learning activities in the community-based organization include the following characteristics?


Never

(0%)

Less than 50% of the time

More than 50% of the time

Always

(100%)

N/A

  1. Service-learners participate in a community needs assessment to plan the service-learning project

  1. The service-learning activities are of a sustained and significant duration (i.e. concentrated blocks of time over a period of several months)

  1. The learning objectives for the service-learning activities are aligned with the academic curriculum

  1. The service-learning activities are included in student records

  1. Community partners collaborate in setting goals and establishing an action plan

  1. Service-learners generate ideas and make decisions on the design and implementation of the service-learning project

  1. Service-learners present their findings from the service-learning project to community members

  1. Service-learners engage with diverse perspectives through the service-learning project

  1. Service-learners examine the broader social and civic context for the identified community need

  1. The project includes a variety of reflection activities that examine changes in service-learners’ knowledge and attitudes

  1. Service-learners measure their progress toward meeting specific service goals and learning outcomes during the project

  1. The service activities present opportunities for the participants to apply newly acquired skills and knowledge to a community need

V. Community Needs and Service Activities


Issue Areas and Community Needs

  1. This question is designed to gather information on the types of community needs that the Learn and Serve America supported service-learning activities have been designed to address. The community needs have been categorized into ten general issue areas. For each issue area, provide the percentage of the service-learning activities that address the relevant issue area. If there are no service activities that address a given area, leave the % field blank (do not enter “0”). For each area with activities, check up to three of the most common types of community needs being addressed by the activities.


Community Development ____ % of service activities

Civic/Public Infrastructure

Homeless Assistance

Transportation

Community Clean-up

Social Services Planning/Delivery

Volunteer Capacity/Management

Historic Preservation

Animal Care Services

Independent Living Assistance



Other Community Development (specify)


Economic Development ____ % of service activities

Financial Literacy

Workforce Development

Financial Asset Development

Economic Revitalization

Technology Access

Other Economic Development (specify)


Disaster Recovery and Relief ____ % of service activities

Disaster Mitigation

Disaster Recovery

Other Disaster (specify)

Disaster Preparedness

Disaster Relief



Education ____ % of service activities

Adult Literacy

Computer Literacy

Special Education Programs

After School Programs

English Language Learning

Classroom Education

Child Literacy

Job Preparedness

Cultural Heritage


School Preparedness

Other Education (specify)


Environment and Energy ____ % of service activities

Clean Air

Environmental Protection

Waste Reduction/Recycling

Clean Water

Environmental Restoration

Weatherization

Energy Conservation

Indoor Environment

Environmental Awareness



Other Environment (specify)


Health & Wellness/Nutrition _____ % of service activities

Disabilities Services

HIV/AIDS Prevention

Nutrition Education

Food Distribution/Collection

Health & Wellness Education

Substance Abuse Prevention/Rehabilitation

Food Production

Maternal/Child Health Services

Aid to Seniors/Elders

Health Service Delivery

Mental Health Services

Other Health/Nutrition (specify)


Public Safety ____ % of service activities

Accident Prevention

Crisis Intervention

Victim/Witness Services

Community Policing

Fire Prevention

Public Safety Education

Conflict Resolution/Mediation

Legal Assistance

Crime Awareness/Prevention

Offender/Ex-Offender Services/Rehabilitation

Children and Youth Safety

Other Public Safety (specify)






Youth Development ____ % of service activities

Children and Youth Safety

Juvenile Justice Services

Bullying Prevention

Delinquency Prevention

Teen Pregnancy/Parenting Services

Other Youth Development (specify)

Gang Prevention/Rehabilitation

Youth Leadership Development



Veterans Assistance ____ % of service activities

Housing Assistance

Military Family Assistance

Veteran Employment Services

Outreach and Counseling

Veteran Disabilities/ Rehabilitation Assistance

Other Veterans (specify)


Service Activities

  1. (For the most common issue area, or the issue area with the highest percentage of activities in question 10) Please provide a brief description (200 word limit) the specific service-learning activities that were used in addressing the community need. In the description, include the goals of the project, the participants and beneficiaries involved, the location of the service-learning activities, and any measured outcomes.

(Note: You only need to provide activities for the most common community need. If desired, you may select a different community need or provide a description of service activities for more than one community need.)


II. Program Reporting Form


B. Institutional Supports for Service-Learning

There are four versions of this section of the survey. Respondents are directed to respond to the appropriate version based on their organizational type. The on-line reporting system automatically identifies the appropriate form type based on the respondents’ answer to question 1 of the Grant Profile. Those who indicated that they are a K-12 school are directed to complete the K-12 School form; those who indicated that they are a K-12 school district are directed to complete the K-12 School District form; those who indicated that they are a higher education institution are directed to complete the Higher Education Institution form; and those who indicated that they are a community-based organization are directed to complete the Community-Based Organization form. NOTE: Recipients of special initiatives under Innovative and Community-Based grant funds, such as Summer of Service and Youth Engagement Zones, are directed to complete distinct surveys.

II-B: K-12 School Version


I. Community Partners

The following questions are designed to gather information on the community partners (community agencies, local government, businesses, etc.) that were formally involved in managing, planning, and/or implementing Learn and Serve America supported service-learning activities with the school during the 2010-2011 program year.


Frame6


  1. How many community partners were involved in Learn and Serve America supporting service-learning activities?


_______ Don’t Know


1a. Of the total number of partners, how many served as a service-learning placement site?


_______ Don’t Know


1b. Of the total number of partners, how many are faith based organizations?


______ Don’t Know


1c. Of the total number of partners, how many provide in-kind or cash support for service-learning?


______ Don’t Know


  1. Does the service-learning program have an advisory board?


Yes No Don’t Know


2a. If YES, do one or more of the community partners serve as members of the advisory board?


Yes No Don’t Know


Collaboration with Other Federal Programs

  1. Which of the following Corporation for National and Community Service programs collaborated with the school in implementing Learn and Serve America service-learning activities? (Check all that apply)

AmeriCorps

Senior Corps

AmeriCorps*VISTA

None

AmeriCorps*NCCC

Don’t Know



  1. Which of the following other federal programs collaborated with the school in implementing the Learn and Serve America service-learning activities? (Check all that apply)

Career and Technical Education

GEAR-UP

Other (specify)

Character Education

21st Century Learning Centers

None

Federal Work Study

Upward Bound

Don’t Know


II. Institutional Supports for Service-Learning

These questions refer to all service-learning activities at the school, whether or not they are supported by Learn and Serve America.


  1. How long have there been organized service-learning activities at the school (e.g. regular, ongoing service-learning)?


One year or less

Two to four years

Five to nine years

Ten years or more

Don’t Know


  1. Please indicate which policies listed below are in place at the school.


Yes

No

Don’t Know

Service-learning is recognized by the school as an improvement strategy in its strategic plan or improvement plan

Service-learning is part of the board approved course curriculum in at least one subject in at least one grade in the school. *(If yes, answer question 7)

Service-learning is part of the board approved course curriculum in at least one course that is a required for graduation.

Service-learning participants are formally recognized through the President’s Volunteer Service Award



  1. * If service-learning is part of the board approved course curriculum in one or more subjects for one or more grades, please indicate the subjects. Check all that apply.

Art/Music/Theater

Math

Vocational/ Career Education

Computer Science

Physical Education

Advisory Period

English/ Language Arts

Science

Elective

Foreign Languages

Social Studies

Gifted/ Talented

Health

Special Education

Other



  1. Indicate the extent to which the following policies and practices were present at the school over the past year:


Never

Rarely

Occasionally

Frequently

Always

Service-learning is included in the school’s current professional development plans

Service-learning is included in new staff and teacher orientation

Service-learning is considered as one of the criteria for teacher and staff evaluations and/or in performance standards for teachers and staff

Students are involved in decision-making about the service-learning activities, for example, through an advisory council or other formal decision-making body

Parent and/or family volunteers participate in service learning activities





  1. During the past year, to what extent were the following available at the school? Please indicate how regularly or widely each type of support was available.



Never

Rarely

Occasionally

Frequently

Always

Financial support for planning, training, and implementation of service-learning projects or programs

Reduction in teaching load to allow time for service-learning program development or supervision

Technical assistance on planning or implementation of service-learning activities

Recognition or rewards for teachers and staff for quality service-learning practice


III. Service-Learning Coordinator


  1. Does the school have a full or part-time service-learning coordinator or staff person with responsibility for service-learning?


Yes No (skip to question 16)


  1. If there is a service-learning coordinator for the school, how many years of professional experience has the coordinator had with service-learning (for example, as a coordinator, teacher, etc.)? If there is more than one coordinator, please provide information on the primary coordinator.


Less than 1 year 1-4 years 5 years or more


  1. Is the service-learning coordinator a full time or part-time employee of the school?


Full-time Part-time


  1. Approximately what percentage of the coordinator’s total job responsibilities is devoted to service-learning?

100 % 75% 50% 25% Less than 25%


  1. Please select the answer that best describes the extent of training and professional development the service-learning coordinator has received.


No formal education, training, or professional development related to service-learning

One workshop, conference, or training session

Multiple workshops, conferences, or training sessions, OR one or more semesters of formal education (pre-service or in-service) focused on service-learning

A combination of a semester or more of formal education and multiple workshops or training sessions

  1. What percentages of the service-learning coordinator’s salary came from grants and institutional funds in 2010-2011 (including Learn and Serve America funds):


Grants _____% Institutional funds _____%




IV. Technical Assistance Strengths and Needs (Optional)

This information may be used to plan peer to peer training.


  1. In which of the following areas do you think your service-learning program is particularly strong and capable of providing technical assistance to other Learn and Serve America programs? Please check all that apply.

Program Management

Program Content

Program Design

Strategic Planning

Developing Community Partnerships

Assessing community impact

Building Community/Institutional Support

Service Site Recruitment

Volunteer/service site training

Staff development/teacher education

Managing/Overseeing Service Sites

Program evaluation strategies/Performance measurement

Financial/grant management

Marketing

Other (specify) ________________________

None

Curriculum/program design (specify subject area)

Development/Leadership

Orientation

Reflection techniques

Youth voice/youth governance

Individual assessment strategies (portfolios, etc.)

Promotion and tenure

Other (specify) _____________________

None




  1. In which of the following areas do you think your service-learning program is most in need of technical assistance or training? Please check the three highest priority areas for assistance.

Program Management

Program Content

Program Design

Strategic Planning

Developing Community Partnerships

Assessing community impact

Building Community/Institutional Support

Service Site Recruitment

Volunteer/service site training

Staff development/teacher education

Managing/Overseeing Service Sites

Program evaluation strategies/Performance measurement

Financial/grant management

Marketing

Other (specify) ________________________


Curriculum/program design (specify subject area)

Development/Leadership

Orientation

Reflection techniques

Youth voice/youth governance

Individual assessment strategies (portfolios, etc.)

Promotion and tenure

Other (specify) _____________________________




II-B: K-12 School District Version


I. Community Partners

The following questions are designed to gather information on the community partners (community agencies, local government, businesses, etc.) that were formally involved in managing, planning, and/or implementing Learn and Serve America supported service-learning activities with the schools during the 2010-2011 program year.


Frame7


  1. How many community partners were involved in Learn and Serve America supporting service-learning activities?


_______ Don’t Know


1a. Of the total number of partners, how many served as a service-learning placement site?


_______ Don’t Know


1b. Of the total number of partners, how many are faith based organizations?


______ Don’t Know


1c. Of the total number of partners, how many provide in-kind or cash support for service-learning?


______ Don’t Know


  1. Does the service-learning program have an advisory board?


Yes No Don’t Know


2a. If YES, do one or more of the community partners serve as members of the advisory board?


Yes No Don’t Know


Collaboration with Other Federal Programs

  1. Which of the following Corporation for National and Community Service programs collaborated in implementing Learn and Serve America service-learning activities in the schools? (Check all that apply)

AmeriCorps

Senior Corps

AmeriCorps*VISTA

None

AmeriCorps*NCCC

Don’t Know


  1. Which of the following other federal programs collaborated in implementing the Learn and Serve America service-learning activities in the schools? (Check all that apply)

Career and Technical Education

GEAR-UP

Other (specify)

Character Education

21st Century Learning Centers

None

Federal Work Study

Upward Bound

Don’t Know

II. Institutional Supports for Service-Learning

These questions refer to all service-learning activities at the district level, whether or not they are funded by Learn and Serve America.


  1. How long have there been organized service-learning activities in the school district (e.g. regular, ongoing service-learning)?


One year or less

Two to four years

Five to nine years

Ten years or more

Don’t Know


  1. Please indicate which policies listed below are in place in the school district.


Yes

No

Don’t Know

Service-learning is recognized by the district as an improvement strategy in its strategic plan or improvement plan

Service-learning is part of the board approved course curriculum in at least one subject in at least one grade in the district. *(If yes, answer question 7)

Service-learning is part of the board approved course curriculum in at least one course that is a required for graduation in the district.

Service-learning participants are formally recognized through the President’s Volunteer Service Award



  1. * If service-learning is part of the board approved course curriculum in one or more subjects for one or more grades, please indicate the subjects. Check all that apply.

Art/Music/Theater

Math

Vocational/ Career Education

Computer Science

Physical Education

Advisory Period

English/ Language Arts

Science

Elective

Foreign Languages

Social Studies

Gifted/ Talented

Health

Special Education

Other



  1. Indicate the extent to which the following policies and practices were present in the school district over the past year:


Never

Rarely

Occasionally

Frequently

Always

Service-learning is included in the district’s current professional development plans

Service-learning is included in new staff and teacher orientation

Service-learning is considered as one of the criteria for teacher and staff evaluations and/or in performance standards for teachers and staff

Students are involved in decision-making about the service-learning activities, for example, through an advisory council or other formal decision-making body

Parent and/or family volunteers participate in service learning activities




  1. During the past year, to what extent were the following available in the school district? Please indicate how regularly or widely each type of support was available.



Never

Rarely

Occasionally

Frequently

Always

Financial support for planning, training, and implementation of service-learning projects or programs

Reduction in teaching load to allow time for service-learning program development or supervision

Technical assistance on planning or implementation of service-learning activities

Recognition or rewards for teachers and staff for quality service-learning practice


III. Service-Learning Coordinator


  1. Is there full or part-time service-learning coordinator(s) or staff person(s) with responsibility for service-learning in the school district?


Yes No (skip to question 16)


  1. If there is a service-learning coordinator in the school district, how many years of professional experience has the coordinator had with service-learning (for example, as a coordinator, teacher, etc.)? If there is more than one coordinator, please provide information on the primary coordinator.


Less than 1 year 1-4 years 5 years or more


  1. Is the service-learning coordinator a full time or part-time employee?


Full-time Part-time


  1. Approximately what percentage of the coordinator’s total job responsibilities is devoted to service-learning?

100 % 75% 50% 25% Less than 25%


  1. Please select the answer that best describes the extent of training and professional development the service-learning coordinator has received.


No formal education, training, or professional development related to service-learning

One workshop, conference, or training session

Multiple workshops, conferences, or training sessions, OR one or more semesters of formal education (pre-service or in-service) focused on service-learning

A combination of a semester or more of formal education and multiple workshops or training sessions

  1. What percentages of the service-learning coordinator’s salary came from grants and institutional funds in 2010-2011 (including Learn and Serve America funds):


Grants _____% Institutional funds _____%







IV. Technical Assistance Strengths and Needs (Optional)

This information may be used to plan peer to peer training.


  1. In which of the following areas do you think your service-learning program is particularly strong and capable of providing technical assistance to other Learn and Serve America programs? Please check all that apply.

Program Management

Program Content

Program Design

Strategic Planning

Developing Community Partnerships

Assessing community impact

Building Community/Institutional Support

Service Site Recruitment

Volunteer/service site training

Staff development/teacher education

Managing/Overseeing Service Sites

Program evaluation strategies/Performance measurement

Financial/grant management

Marketing

Other (specify) ________________________

None

Curriculum/program design (specify subject area)

Development/Leadership

Orientation

Reflection techniques

Youth voice/youth governance

Individual assessment strategies (portfolios, etc.)

Promotion and tenure

Other (specify) _____________________

None




  1. In which of the following areas do you think your service-learning program is most in need of technical assistance or training? Please check the three highest priority areas for assistance.

Program Management

Program Content

Program Design

Strategic Planning

Developing Community Partnerships

Assessing community impact

Building Community/Institutional Support

Service Site Recruitment

Volunteer/service site training

Staff development/teacher education

Managing/Overseeing Service Sites

Program evaluation strategies/Performance measurement

Financial/grant management

Marketing

Other (specify) ________________________


Curriculum/program design (specify subject area)

Development/Leadership

Orientation

Reflection techniques

Youth voice/youth governance

Individual assessment strategies (portfolios, etc.)

Promotion and tenure

Other (specify) _____________________________




II-B: Higher Education Institution Version


I. Community Partners


The following questions are designed to gather information on the community partners (community agencies, local government, businesses, etc.) that were formally involved in managing, planning, and/or implementing Learn and Serve America supported service-learning activities with the higher education institution during the 2010-2011 program year.


Frame8


  1. How many community partners were involved in Learn and Serve America supporting service-learning activities?


_______ Don’t Know


1a. Of the total number of partners, how many served as a service-learning placement site?


_______ Don’t Know


1b. Of the total number of partners, how many are faith based organizations?


______ Don’t Know


1c. Of the total number of partners, how many provide in-kind or cash support for service-learning?


______ Don’t Know


  1. Does the service-learning program have an advisory board?


Yes No Don’t Know


2a. If YES, do one or more of the community partners serve as members of the advisory board?


Yes No Don’t Know


Collaboration with Other Federal Programs

  1. Which of the following Corporation for National and Community Service programs collaborated with the higher education institution in implementing Learn and Serve America service-learning activities? (Check all that apply)

AmeriCorps

Senior Corps

AmeriCorps*VISTA

None

AmeriCorps*NCCC

Don’t Know



  1. Which of the following other federal programs collaborated with the higher education institution in implementing the Learn and Serve America service-learning activities? (Check all that apply)

Career and Technical Education

GEAR-UP

Other (specify)

Character Education

21st Century Learning Centers

None

Federal Work Study

Upward Bound

Don’t Know


II. Institutional Supports for Service-Learning

These questions refer to all service-learning activities at the higher education institution, whether or not they are supported by Learn and Serve America.


  1. How long have there been organized service-learning activities at the higher education institution (e.g. regular, ongoing service-learning)?


One year or less

Two to four years

Five to nine years

Ten years or more

Don’t Know


  1. Please indicate which policies listed below are in place at the higher education institution.


Yes

No

Don’t Know

Service-learning is included in the campus strategic plan.

Service-learning is part of the official core curriculum in at least one discipline or major at the institution *(If yes, answer question 7)

Service-learning is part of the official core curriculum in at least one course that is required for graduation.

Public or institution-wide recognition is given to students receiving the President’s Volunteer Service Award



  1. *If service-learning is part of the official core curriculum in at least one discipline or major, please indicate the subject(s). Check all that apply.

Arts

Law/Criminal Justice

Social Work

Education

Public Policy/Public Administration

Vocational/Technical

Health Sciences/Professions

Sciences/Mathematics/Engineering

Other

Humanities

Social Sciences




  1. During the past year, how many courses with service-learning activities were created at the higher education institution as result of Learn and Serve America funds?


__________ Estimated number of courses Don’t Know



  1. Indicate the extent to which the following policies and practices were present at the higher education institution over the past year:


Never

Rarely

Occasionally

Frequently

Always

Service-learning is included in the institution’s current professional development plans

Service-learning is included in the orientation for new faculty

Service-learning is considered as one of the criteria in faculty promotion and/or tenure.

Students are involved in decision-making about the service-learning activities, for example, through an advisory council or other formal planning or decision-making body



  1. During the past year, to what extent were the following available at the higher education institution? Please indicate how regularly or widely each type of support was available.


Never

Rarely

Occasionally

Frequently

Always

Financial support for planning, training, and implementation of service-learning projects or programs

Reduction in course load to allow time for service-learning program development or supervision

Technical assistance on planning or implementation of service-learning activities

Recognition or rewards for faculty and staff for quality service-learning practice



III. Service-Learning Coordinator


  1. Does the higher education institution have a full or part-time service-learning coordinator(s) or staff person(s) with responsibility for service-learning?

Yes No (skip to question 17)


  1. If there is a service-learning coordinator for the higher education institution, how many years of professional experience has the coordinator had with service-learning (for example, as a coordinator, faculty member, etc.)? If there is more than one coordinator, please provide information on the primary coordinator.


Less than 1 year 1-4 years 5 years or more


  1. Is the service learning coordinator a full time or part-time employee of the higher education institution?


Full-time Part-time


  1. Approximately what percentage of the coordinator’s total job responsibilities is service-learning?

100 % 75% 50 % 25% Less than 25%



  1. Please select the answer that best describes the extent of training/professional development the service-learning coordinator has received:


No formal education/training/professional development related to service-learning

One workshop, conference, or training session

Multiple workshops/conferences/training sessions, OR one or more semesters of formal education
(pre-service or in-service) focused on service-learning

A combination of a semester or more of formal education and multiple workshops/training sessions.

  1. What percentage of the service-learning coordinator’s salary is from grants and institutional funds in 2010-2011 (including Learn and Serve America funds):


Grants _____% Institutional funds _____%






IV. Technical Assistance Strengths and Needs (Optional)

This information may be used to plan peer to peer training.


  1. In which of the following areas do you think your service-learning program is particularly strong and capable of providing technical assistance to other Learn and Serve America programs? Please check all that apply.

Program Management

Program Content

Program Design

Strategic Planning

Developing Community Partnerships

Assessing community impact

Building Community/Institutional Support

Service Site Recruitment

Volunteer/service site training

Staff development/teacher education

Managing/Overseeing Service Sites

Program evaluation strategies/Performance measurement

Financial/grant management

Marketing

Other (specify) ________________________

None

Curriculum/program design (specify subject area)

Development/Leadership

Orientation

Reflection techniques

Youth voice/youth governance

Individual assessment strategies (portfolios, etc.)

Promotion & tenure

Other (specify) _____________________

None




  1. In which of the following areas do you think your service-learning program is most in need of technical assistance or training? Please check the three highest priority areas for assistance.

Program Management

Program Content

Program Design

Strategic Planning

Developing Community Partnerships

Assessing community impact

Building Community/Institutional Support

Service Site Recruitment

Volunteer/service site training

Staff development/teacher education

Managing/Overseeing Service Sites

Program evaluation strategies/Performance measurement

Financial/grant management

Marketing

Other (specify) ________________________


Curriculum/program design (specify subject area)

Development/Leadership

Orientation

Reflection techniques

Youth voice/youth governance

Individual assessment strategies (portfolios, etc.)

Promotion & tenure

Other (specify) _____________________

None





II-B: Community-Based Organization Version


I. Community Partners

The following questions are designed to gather information on the community partners (community agencies, schools, local government, businesses, etc.) that were formally involved in managing, planning, and/or implementing Learn and Serve America supported service-learning activities during the 2010-2011 program year.


Frame9


  1. How many community partners were involved in Learn and Serve America supporting service-learning activities?


_______ Don’t Know


1a. Of the total number of partners, how many served as a service-learning placement site?


_______ Don’t Know


1b. Of the total number of partners, how many are faith based organizations?


______ Don’t Know


1c. Of the total number of partners, how many provide in-kind or cash support for service-learning?


______ Don’t Know


  1. Does the service-learning program have an advisory board?


Yes No Don’t Know


2a. If YES, do one or more of the community partners serve as members of the advisory board?


Yes No Don’t Know


Collaboration with Other Federal Programs

  1. Which of the following Corporation for National and Community Service programs collaborated with the organization in implementing Learn and Serve America service-learning activities? (Check all that apply)

AmeriCorps

Senior Corps

AmeriCorps*VISTA

None

AmeriCorps*NCCC

Don’t Know



  1. Which of the following other federal programs collaborated with the organization in implementing the Learn and Serve America service-learning activities? (Check all that apply)

Career and Technical Education

GEAR-UP

Other (specify)

Character Education

21st Century Learning Centers

None

Federal Work Study

Upward Bound

Don’t Know


II. Institutional Supports for Service-Learning

These questions are about all service-learning in your organization.


  1. How long have there been organized service-learning activities at the organization (e.g. regular, ongoing service-learning)?


One year or less

Two to four years

Five to nine years

Ten years or more

Don’t Know


  1. Please indicate which policies listed below are in place at the organization.


Yes

No

Don’t Know

Service-learning is included in the organization’s strategic plan.

Service-learning is part of the activities for youth in at least one program or department in the organization.

Participation in service-learning is a requirement for the youth participants in the organization.

Service-learning participants are formally recognized through the President’s Volunteer Service Award



  1. Indicate the extent to which the following policies/practices were present at the organization over the past year:


Never

Rarely

Occasionally

Frequently

Always

Service-learning is included in the organization’s current professional development plans

Service-learning is included in new staff orientation

Service-learning is considered as one of the criteria for staff evaluations and/or performance standards

Young people are involved in decision-making about the service-learning activities in the organization, for example, through an advisory council or other formal planning or decision-making body



  1. During the past year, to what extent were the following available at the organization? Please indicate how regularly or widely each type of support is available


Never

Rarely

Occasionally

Frequently

Always

Financial support for planning, training, and implementation of service-learning projects or programs

Reduction in work load to allow time for service-learning program development or supervision

Recognition or rewards for staff for quality service-learning practice

Technical assistance on planning or implementation of service-learning activities



III. Service-Learning Coordinator


  1. Does the organization have a full or part-time service-learning coordinator or staff person with responsibility for service-learning?


Yes No (skip to question 15)


  1. If there is a service-learning coordinator for the organization, how many years of professional experience has the coordinator had with service-learning (for example, as a coordinator, former teacher, etc.)? If there is more than one coordinator, please provide information on the primary coordinator.


Less than 1 year 1-4 years 5 years or more



  1. Is the service learning coordinator a full time or part-time employee of the organization?


Full-time Part-time


  1. Approximately what percentage of the coordinator’s total job responsibilities is devoted to service-learning?


100 % 75% 50% 25% Less than 25%


  1. Please select the answer that best describes the extent of training/professional development the service-learning coordinator has received:


No formal education/training/professional development related to service-learning

One workshop, conference, or training session

Multiple workshops/conferences/training sessions, OR one or more semesters of formal education
(pre-service or in-service) focused on service-learning

A combination of a semester or more of formal education and multiple workshops/training sessions.

  1. What percentage of the service-learning coordinator’s salary is from grants and organization operating funds in 2010-2011 (including Learn and Serve America funds):


Grants _____% Organizational operating funds _____%




IV. Technical Assistance Strengths and Needs (Optional)

This information may be used to plan peer to peer training.


  1. In which of the following areas do you think your service-learning program is particularly strong and capable of providing technical assistance to other Learn and Serve America programs? Please check all that apply.

Program Management

Program Content

Program Design

Strategic Planning

Developing Community Partnerships

Assessing community impact

Building Community/Institutional Support

Service Site Recruitment

Volunteer/service site training

Staff development/teacher education

Managing/Overseeing Service Sites

Program evaluation strategies/Performance measurement

Financial/grant management

Marketing

Other (specify) ________________________

None

Curriculum/program design (specify subject area)

Development/Leadership

Orientation

Reflection techniques

Youth voice/youth governance

Individual assessment strategies (portfolios, etc.)

Other (specify) _____________________

None




  1. In which of the following areas do you feel your service-learning program is most in need of technical assistance or training? Please check the three highest priority areas for assistance.

Program Management

Program Content

Program Design

Strategic Planning

Developing Community Partnerships

Assessing community impact

Building Community/Institutional Support

Service Site Recruitment

Volunteer/service site training

Staff development/teacher education

Managing/Overseeing Service Sites

Program evaluation strategies/Performance measurement

Financial/grant management

Marketing

Other (specify) ________________________


Curriculum/program design (specify subject area)

Development/Leadership

Orientation

Reflection techniques

Youth voice/youth governance

Individual assessment strategies (portfolios, etc.)

Other (specify) _____________________

None


II. Program Reporting Form


C. Training and Technical Assistance Activities

I. Training and Technical Assistance (Only for those who indicated that they provided training and technical assistance under question 3 of the Registration Form)


Please provide information on the training and technical assistance that your organization provided during the 2010-2011 program year that was supported by Learn and Serve America funds.


  1. How many teachers, faculty and/or staff participated in training and technical assistance activities that were supported by Learn and Serve America grants funds during the 2010-2011 program year?


_______Number None Don’t Know


  1. [If respondent reported teachers, faculty and/or staff in 33] How many teachers, faculty and/or staff participated in each of the following types of training and technical assistance activities?



Number

Don’t Know

1-day in-person service-learning institute


In-person service-learning institute that lasted more than one day


Webinars


Discussion lists, wikis, and other forums for electronic collaboration


In-person meetings with representatives of community partner organizations


Opportunities to participate in Professional Learning Communities


Opportunities to work with a mentor who has experience using service-learning


Opportunities to take part in service-learning projects as participants/service-learners


Training and/or technical assistance for including service-learning within existing methods courses [HED ONLY]


Training and/or technical assistance for including service-learning within existing foundations courses [HED ONLY]


Training and/or technical assistance for providing stand-alone courses in service-learning pedagogy [HED ONLY]



  1. How many college students participated in training and technical assistance activities that were supported by Learn and Serve America grant funds during the 2010-2011 program year?


_______ Number None Don’t Know


35a. How many of the college students that participated in training and technical assistance activities were pre-service teachers?


_______ Number None Don’t Know


  1. [If respondent reported college students in 35] How many college students participated in each of the following types of training and technical assistance activities?



Number

Don’t Know

1-day in-person service-learning institute


In-person service-learning institute that lasted more than one day


Webinars


Discussion lists, wikis, and other forums for electronic collaboration


In-person meetings with representatives of community partner organizations


Opportunities to participate in Professional Learning Communities


Opportunities to work with a mentor who has experience using service-learning


Opportunities to take part in service-learning projects as participants/service-learners


Training and/or technical assistance for including service-learning within existing methods courses [HED ONLY]


Training and/or technical assistance for including service-learning within existing foundations courses [HED ONLY]


Training and/or technical assistance for providing stand-alone courses in service-learning pedagogy [HED ONLY]



  1. Please provide a brief description (100-150 words) of the training and technical assistance activities that were supported by Learn and Serve America funds. The description may include any special initiatives that you introduced, areas covered by training and technical assistance, and subject or service areas for curricula developed, as well as the number and type of school, teachers, staff, and students involved in these activities.


1

2011 Learn and Serve America Program and Performance Report

K12, HED, CBO Grants

File Typeapplication/msword
File Title2003-2004 Program Reporting and Performance Measurement Form
AuthorAlan Melchior
Last Modified Bymhatch
File Modified2010-09-08
File Created2010-09-08

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