5. CAPE-Youth PD Study Demographic Items final IRB approved

CAPE-Youth

Demographic Questions for PD Group Concept Mapping

OMB Control No: 1230-0NEW

Expiration Date: XX/XX/20XX

DEMOGRAPHIC INFORMATION CAPTURED IN GROUPWISDOM™

Demographic Fields

“Hello, and welcome! You have been asked to participate in a web-based project. Your participation is voluntary. The project will collect data by asking participants to do some or all of these activities: giving your ideas, rating ideas, sorting the ideas into groups with similar themes, and providing non-identifying information about yourself. You may be asked to offer your input in one or more of these ways. You may participate in the entire project or in any of these activities. Your input in this project is private.”

1. State/territory in which you work/provide services (this will be a dropdown)

Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming

2. Please indicate your primary role/field of work

1. Teacher in Pre-K-12/Secondary Education

2. Administrator in Pre-K-12/Secondary Education

3. Program Specialist of State Education Agency

4. Administrator of State Education Agency

5. Instructor in Community College

6. Administrator/Disability Services Coordinator in Community College

7. Instructor/Professor in 4-year College/University

8. Administrator/Disability Services Coordinator in 4-year College/University

9. Instructor in Career and Technology Education

10. Administrator in Career and Technology Education

11. Support Services Coordinator in Developmental Disability Agency

12. Administrator in Developmental Disability Agency

13. Counselor in Vocational Rehabilitation (VR)

14. Administrator in Vocational Rehabilitation (VR)

15. Project Staff or Coordinator in Title I WIOA-Funded Workforce Systems

16. Administrator in Title I WIOA-Funded Workforce Systems

17. Instructor in Title II Adult Education

18. Administrator in Title II Adult Education

19. Social Worker in Child Welfare

20. Administrator in Child Welfare

21. Specialist/Counselor in Juvenile Justice

22. Administrator in Juvenile Justice

23. Counselor/Program Coordinator Mental Health Agency

24. Administrator in Mental Health Agency

25. Benefits Planning Specialist in Social Security Administration

26. Administrator in Social Security Administration

27. Program Staff of Professional Associations

28. Administrator of Professional Associations

29. Program Coordinator/Service Provider in Nonprofit Organizations

30. Administrator in Nonprofit Organizations

31. Other Role in Youth Serving Agencies (Please indicate)

3. How many years have you worked in your current field (open text box)

4. Of the populations listed below, which ones do you serve in your current role? (check all that apply)

   1. K-12 in school youth/students with disabilities

   2. Out of school youth with disabilities (youth ages 16-24 not in school)

   3. Opportunity youth with disabilities (i.e., youth between the ages of 14-24 who may represent one or more of the following categories) (check all that apply)

      1. Dropped out of high school

      2. Pregnant and parenting youth

      3. Minority group (racially and ethnically diverse)

      4. Foreign language speakers

      5. Immigrant, migrant, and/or refugees

      6. LGBTQ+

      7. Have experienced or are experiencing homelessness

      8. Involvement with the juvenile justice system

      9. Involvement with child welfare/foster care

      10. Residing in a rural area

   4. Undergraduate or graduate students who will work in fields supporting youth with disabilities

   5. Adults who support youth with disabilities

   6. Adults with disabilities

5. Considering the populations you indicated serving in the previous question, please choose the primary population you serve? (select only one)

   1. K-12 in school youth/students with disabilities

   2. Out of school youth with disabilities (youth ages 16-24 not in school)

   3. Opportunity youth with disabilities (i.e., youth between the ages of 14-24 who may represent one or more of the following categories) (check all that apply)

      1. Dropped out of high school

      2. Pregnant and parenting youth

      3. Minority group (racially and ethnically diverse)

      4. Foreign language speakers

      5. Immigrant, migrant, and/or refugees

      6. LGBTQ+

      7. Have experienced or are experiencing homelessness

      8. Involvement with the juvenile justice system

      9. Involvement with child welfare/foster care

      10. Residing in a rural area

   4. Undergraduate or graduate students who will work in fields supporting youth with disabilities

   5. Adults who support youth with disabilities

   6. Adults with disabilities

6. Does your agency/organization provide direct services to youth with disabilities?

• Yes

  • In your current role, do you provide direct services to youth with disabilities?

    • Yes

    • No

• No

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays an Office of Management and Budget (OMB) control number. The valid OMB Control Number for this information collection is xxxx-xxxx. The time required to participate in the questionnaire is estimated to average 100 minutes, including the time to review instructions, search existing data resources, gather the data needed and complete and review the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to US Department of Labor, Office of Disability Employment Policy, 200 Constitution Ave., N.W. Washington, DC 20210 and reference the OMB Control Number xxxx-xxxx.

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Collection and Use of Personal Information

The following statement is made in accordance with the Privacy Act of 1974 (5. U. S. C. 552a). Information collected will be handled and stored in compliance with the Freedom of Information Act and the Privacy Act of 1974, as amended (5 U.S.C. 552a). Furnishing the data requested is voluntary.

We will use the data you provide for the CAPE-Youth Research Project, funded by The United States Department of Labor, Office of Disability Employment Policy. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data.