DRAFT NEEDS ASSESSMENT TEMPLATE
As we continue gathering information from your state to inform the technical assistance to be provided by the Safe and Supportive Schools Technical Assistance Center (SSSTA), we would appreciate your responses to the questions in this LEA Needs Assessment Summary. The information you provide will guide our planning for the best technical assistance, training and support to help you address the needs of your LEAs.
Please provide as much information as possible at this time. Responses should be completed electronically. Please enter your information within each space provided. Text boxes will open up automatically as you write, so you can enter as much information as needed.
Please email this document to Sally Ruddy at American Institutes for Research (sruddy@air.org) by noon EST on:
September 15, 20XX for grantees who collected their survey data by June 20XX
November 1, 20XX for grantees who collected their survey data after June 20XX
Be sure to keep a copy for your records. Please feel free to email her if you have any questions.
Please complete the table below.
Name of State
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Number of participating LEAs in State *
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Name Of Person Completing Form
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Title/Position
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Telephone Number
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E-Mail Address
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Best Days And Times To Reach You (In Case Further Questions Arise) |
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*Please attach a list of participating LEAs in your state, if available.
The purpose of this document is to summarize information collected from your participating LEAs about their current conditions for learning and school climate related needs. Information may be obtained from your LEAs’ survey and incident data, or from additional information you may have collected in a needs assessment completed by your LEAs.
NOTE: The Center would like to know the extent to which LEAs across the 11 SSS grantees are experiencing the same needs. Thus, the following questions ask you to enter the number of participating LEAs that pertain to each response. If, for your own use, you would like to also enter the names of the LEAs, feel free to do so, but it is not necessary for the purposes of this summary.
If you do not have the information requested here based on the data you are using to assess LEA needs, please estimate and mark your estimations with an asterisk (e.g., 24*).
Do your participating LEAs have the school year (SY) 2010-11 survey data their participating schools collected?
Have data? (Yes/No) |
Respondent group |
Number of LEAs |
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Students |
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Staff |
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Parents/Guardians |
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Do your participating LEAs have the incident data their participating schools collected?
Have data? (Yes/No) |
Number of LEAs |
Yes |
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No |
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Which school climate needs were identified by survey data collected in your participating LEAs during SY 201011? If known, please identify whether each need:
is district-wide (i.e., pertains to all students), or
differs by school or respondent subgroup demographic factors (gender, race/ethnicity, socioeconomic status, etc).
From student surveys [Add rows as needed]
Needs identified (enter below) |
District-wide? (yes/no) |
Differs by school or subgroup? (yes/no) |
Do not know if district-wide or school/ subgroup |
Number of LEAs |
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From staff surveys [Add rows as needed]
Needs identified (enter below) |
District-wide? (yes/no) |
Differs by school or subgroup? (yes/no) |
Do not know if district-wide or school/ subgroup |
Number of LEAs |
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From parent/guardian surveys [Add rows as needed]
Needs identified (enter below) |
District-wide? (yes/no) |
Differs by school or subgroup? (yes/no) |
Do not know if district-wide or school/ subgroup |
Number of LEAs |
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What needs were identified by the incident data collected by your participating LEAs? Please identify whether each need:
is district-wide (i.e., pertains to all students), or
differs by school or respondent subgroup demographic factors (gender, race/ethnicity, socioeconomic status, etc).
[Add rows as needed]
Needs identified (enter below) |
District-wide? (yes/no) |
Differs by school or subgroup? (yes/no) |
Do not know if district-wide or school/ subgroup |
Number of LEAs |
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Is the incident data you reported in the questions above from SY 2010-11 or from SY 2009-10?
Incident data is from school year: |
Number of LEAs |
2010-11 |
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2009-10 |
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Overall, how experienced do you feel your LEAs are at reporting out/disseminating data to various stakeholder groups? Please consider both internal resources and external consultant or contractor expertise in your rating.
[List the number of participating LEAs applicable for each category of experience]
Level of Experience at Reporting Out/Disseminating Data |
Number of LEAs |
Highly experienced |
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Experienced |
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Somewhat experienced |
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Not at all experienced |
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What programmatic interventions are your participating LEAs currently implementing to address the needs identified above (e.g. data management system; planning and training; promotion and prevention programs; services and supports by community providers; social marketing campaigns; other)?
Please provide a list of strategies/interventions/programs.
If an assessment of a current program has been done, please attach the summary or report to this document, if available.
[Add rows as needed]
Current programmatic interventions being implemented (enter below) |
Assessment done? |
Number of LEAs |
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Do any programmatic interventions still need to be chosen based on the needs identified in your LEAs’ data? [Please enter any needs still unaddressed for which programs need to be identified.]
[Add rows as needed]
Unaddressed need(s) (enter below) |
Number of LEAs |
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What technical assistance will you need to help LEAs choose programmatic interventions? [Enter response in box below]
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What technical assistance will you need to help LEAs implement programmatic interventions?
[Enter response in box below]
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How and to what extent are survey and incident data currently used to inform LEA activities or district and school programming? [Enter response in box below]
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What training or technical assistance activities, if any, have been planned for SY 2011-12 to address your LEAs’ needs? Please indicate:
the approximate month of each planned activity; and
who will be conducting each planned activity (e.g., SEA, LEA, state-contracted technical assistance center, consultant).
[Add rows as needed]
Planned training or technical assistance activities (enter below) |
Approximate month of planned activity |
Who will conduct the planned activity? |
Number of LEAs |
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Public Burden Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 60 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is voluntary. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20202-4536 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1800-0011. Note: Please do not return the completed Needs Assessment Survey to this address.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Rachel Goins |
| File Modified | 0000-00-00 |
| File Created | 2021-02-01 |