Form Digital Inclusion Digital Inclusion Digital Inclusion Pilot Project Survey

1
Appendix A: Digital Inclusion Corps Pilot Project (DICPP)
The Digital Inclusion Corps Pilot Project (DICPP) surveys will collect pre/post project information from
anchor institutions (host organizations) and local DICPP community collaborators (partners).
Data collection activities will also be conducted with DICPP leadership and project team members to
monitor and validate outputs and outcomes during the project planning and implementation phases.
The timeframe of the Digital Inclusion Corps Pilot Project is May, 2017 through January, 2018.
DICPP Anchor Organization Pre-Project Survey:
DICPP Local Organization Pre-Project Survey:

(14 days after OMB approval)
(30-45 days after OMB approval)

Data will be collected in the early phases of project implementation to gather information on participating
organizations’ engagement with certain demographic groups and their “current state” of Digital Inclusion
activities.
DICPP Anchor and Local Organization Post-Project Survey:
(November/December, 2017)
Data will be collected using the same survey format as the pre-project survey to gather information on
output and outcomes of the pilot project.
DICPP Anchor Organization End of Project Survey:
Surveys questions will use Likert Scale response options.

(December, 2017)

DICPP National Leadership Team Project Implementation Data Collection: (On-going, 2017)
Data will be collected from the national leadership team members including National Digital Inclusion
Alliance and PAST Foundation (NDIA-PAST) the DICPP Project Manager and DICPP Corps Members.
Data collection activities are designed to monitor progress on key deliverables and to tract outputs and
outcomes as articulated in the timeline of the Institute of Museum and Library Sciences (IMLS) National
Leadership Grant-Museum proposal (NLG-Museums FY 16).

Survey and Evaluation Overview:
Surveys questions will use YES/NO, Multiple Choice and Likert Scale response options.
Harkin Consulting Services will not administer surveys or collect data from individuals, prioritized target
groups or other beneficiaries directly receiving services or trainings delivered by participating local
organizations or Digital Inclusion Corps members.
Surveys will be given a maximum of 3 times. Each survey will take less than 20 minutes to complete.
Surveys will be conducted two to four weeks after OMB approval through December, 2017. Participants
will be members identified in the original proposal (i.e. Anchor Institution representatives, NIDA-PAST,
Digital Inclusion Project Manager, Digital Inclusion Corps staff, local collaborators and Steering Team
members)

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Digital Inclusion Corps Pilot Project Survey
Individual Contact and Organizational Information
1. Confidentiality review and agreement to participate in survey activities
This is a confidential survey, unless otherwise required by law. Data from this survey will be reported in
aggregate. No one other than the researchers will know individual answers to this questionnaire, unless
otherwise required by law. Survey data will be used to assess the effect of digital inclusion activities lead
by museums/libraries that include participation from their community. Completing this survey will give
you the opportunity to share your experience with the project.
By checking the response below, you agree to participate and confirm you understand your participation in
the project is completely voluntary. You may decline altogether, or leave blank any questions you don’t
wish to answer. There are no known risks to participation beyond those encountered in everyday life.
I agree to participate in this confidential survey.

If YES, Continue
If NO, End Survey
2. What is the name of your organization?
3. What is your role within the organization? (i.e. senior leader, manager, staff, Digital Inclusion
Corps member)

4. Are you the point of contact/designee within your organization for the Digital Inclusion Corps
Pilot Project?
If YES, Continue
If NO, End Survey.
5. What is the formal mission of your organization? (Comment box)
6. Where is your organization located? (Alaska, Arizona, Minnesota, New Mexico, Oklahoma)
7. Do you serve federal or state recognized tribal groups?
(Y/N/Unsure)
8. My organization is:
The designated Anchor Institution for the Digital Inclusion Corps Pilot Project
A local collaborator/partner in the Digital Inclusion Corps Pilot Project

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ANCHOR INSTITUTION PRE-PILOT DIGITAL INCLUSION PILOT PROJECT SURVEY
9. Has your organization promoted/secured resources and/or implemented activities to address
Digital Inclusion in your community? (Y/N/Unsure)
If “NO” or “UNSURE” Skip
If “YES” (9a)
Did your Digital Inclusion activities include any of the following?
Affordable, robust broadband internet service
(Y/N/Unsure)
Internet-enabled devices that meet the needs of the user
(Y/N/Unsure)
Digital literacy training
(Y/N/Unsure)
Quality technical support
(Y/N/Unsure)
Applications and online content designed to enable and encourage self-sufficiency,
participation and collaboration
(Y/N/Unsure)
If “NO” or “UNSURE” (#9) Skip
If “YES” (9b)
What activities has your organization undertaken to address Digital Inclusion?
(PLEASE CHECK ALL THAT APPLY)
•
Provide digital literacy training at our facility
•
Provide digital literacy training off site in places convenient to community
members (i.e., senior homes, community centers, homeless shelters)
•
Develop tailored classes to meet specific needs (i.e. create email or social media
accounts, register for services/benefits/employment, attach documents to email, etc.)
•
Provide facilities, technology or internet access for community organizations
•
Provide facilities, technology or internet access for individuals
•
Respond to specific requests for technical assistance from individuals
•
Promote/secure home broadband services for eligible populations
•
Promote/secure affordable computing devices for eligible populations
•
Other
If “NO” or “UNSURE” (#9) Skip
If “YES” (9c)
What demographic groups has your organization engaged for Digital Inclusion activities?
(PLEASE CHECK ALL THAT APPLY)
•
Youth
•
Tribal communities
•
American Indian organizations/associations
•
Alaskan Native organizations/associations
•
Small/remote underserved communities
•
Economically and socially disadvantaged populations
•
Developmental, mental and/or physically disabled populations
•
Women
•
Retired and older adults
•
Veterans
•
Rural residents
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•
•
•

Urban and/or suburban residents
Individuals with some difficulty with the English language and/or Non English speakers
Other

If “NO” or “UNSURE” (#9) Skip
If “YES” (9d)
Do you provide opportunities for participants to provide feedback on Digital Inclusion activities?
(Y/N/Unsure)
If “NO” or “UNSURE” (#9d) Skip
If “YES” (9e)
(PLEASE CHECK ALL THAT APPLY)
•
Survey (paper)
•
Survey (online)
•
Verbal to an organizational representative
•
Other (Please describe briefly)
10. Does your organization collaborate with other local organizations to enhance Digital Inclusion in
your community? (Y/N/Unsure)
If “NO” or “UNSURE” (#10) Skip
If “YES” (#10a)
•
Culture/Art/History
•
Education: PreK-12
•
Education: Higher Education
•
Education: Workforce Development/Career Services
•
Education: Informal/out of school programs
•
Disability Services organizations
•
Public Health/Medical community
•
Human and Social Services
•
Community based organizations
•
Business community
•
Faith based organizations
•
Local government
•
American Indian organizations/ associations
•
Alaskan Native organization/associations
•
Other
If “YES” (#10b)
What Digital Inclusion collaborations/activities have you conducted in your community?
(PLEASE CHECK ALL THAT APPLY)
•
Provided educational presentations about Digital Inclusion
•
Convened conversations to discuss the state of Digital Inclusion for specific populations
•
Participated in joint partnerships to address Digital Inclusion
•
Conducted targeted outreach to specific demographic groups
•
Developed strategies to enhance Digital Inclusion in your community
•
Pursued resources to expand Digital Inclusion activities (funds, computers, expanded
broadband capacity)
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•

Other

11. Have you identified collaborating organizations or partners who will participate in the Digital
Inclusion Corps Pilot Project? (Y/N/Unsure)
If “NO” or “UNSURE” (#11) Skip
If “YES” (#11a)
What sectors do they represent?
(PLEASE CHECK ALL THAT APPLY)
•
Culture/Art/History
•
Education: PreK-12
•
Education: Higher Education
•
Education: Workforce Development/Career Services
•
Education: Informal/out of school programs
•
Disability Services organizations
•
Public Health/Medical community
•
Human and Social Services
•
Community based organizations
•
Business community
•
Faith based organizations
•
Local government
•
American Indian organizations/ associations
•
Alaskan Native organization/associations
•
Other

12. Have you identified prioritized demographic groups to participate in the Digital Inclusion Corps
Pilot project? (Y/N/Unsure)
If “NO” or “UNSURE” (#12) Skip
If “YES” (#12a)
Which demographic groups will participate in the Digital Inclusion Corps Pilot project?
(PLEASE CHECK ALL THAT APPLY)
•
Youth
•
Tribal communities
•
American Indian organizations/ associations
•
Alaskan Native organization/associations
•
Small/remote and underserved communities
•
Economically and socially disadvantaged populations
•
Developmental, mental and/or physically disabled populations
•
Women
•
Retired and older adults
•
Veterans
•
Rural residents
•
Urban and/or suburban residents
•
Individuals with some difficulty with the English language and/or Non English speakers
•
Other
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13. Are your prioritized groups likely to be digitally disconnected or lack digital literacy?
(Y/N/Unsure)

14. Does your organization have a plan of action for Digital Inclusion activities/goals?
(Y/N/Unsure)
If “NO” or “UNSURE” (#14) Skip
If “YES” (#14a)
Is there a timeframe for activities within the Digital Inclusion plan of action?
If “NO” or “UNSURE” (#14) Skip
If YES (#14b)
What is the timeframe? 1 year/2 years/3 years/Other (Please describe)
If “NO” or “UNSURE” (#14) Skip
If YES (#14c)
Does the organization’s Digital Inclusion plan of action include metrics to measure outcomes
and/or progress? (Y/N/Unsure)
15. Does your organization have a Mission, Vision and/or Values statement regarding Digital
Inclusion? (Y/N/Unsure)
If “NO” or “UNSURE” (#15) Skip
If YES (#15a)
Does your Digital Inclusion statement address access to and use of:
Affordable, robust broadband internet service?
(Y/N/Unsure)
Internet-enabled devices that meet the needs of the user?
(Y/N/Unsure)
Digital literacy training?
(Y/N/Unsure)
Quality technical support?
(Y/N/Unsure)
Applications and online content designed to enable and encourage self-sufficiency,
participation and collaboration?
(Y/N/Unsure)

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ANCHOR INSTITUTION POST-PILOT DIGITAL INCLUSION PILOT PROJECT SURVEY
1. Did your organization promote/secure resources and/or implement activities to address Digital
Inclusion in your community? (Y/N/Unsure)
If “NO” or “UNSURE” (#1) Skip
If YES (#1a)
Did your Digital Inclusion activities focus on:
Affordable, robust broadband internet service?
(Y/N/Unsure)
Internet-enabled devices that meet the needs of the user?
(Y/N/Unsure)
Digital literacy training?
(Y/N/Unsure)
Quality technical support?
(Y/N/Unsure)
Applications and online content designed to enable and encourage self-sufficiency,
participation and collaboration?
(Y/N/Unsure)
If “NO” or “UNSURE” (#1) Skip
If YES (#1b)
What Digital Inclusion activities did you conduct in your community during the Digital Inclusion Corps
Pilot project?
(PLEASE CHECK ALL THAT APPLY)
•
Provided educational presentations about Digital Inclusion
•
Convened conversations to discuss the state of Digital Inclusion for specific populations
•
Participated in joint partnerships to address Digital Inclusion
•
Conducted targeted outreach to specific demographic groups
•
Developed strategies to enhance Digital Inclusion in your community
•
Pursued resources to expand Digital Inclusion activities (funds, computers, expanded
broadband capacity)
•
Other
2. What types of collaborating organizations participated in the Digital Inclusion Corps Pilot Project?
(PLEASE CHECK ALL THAT APPLY)
• Culture/Art/History
• Education: Pre K12
• Education: Higher Education
• Education: Workforce Development/Career Services
• Disability Services organizations
• Public Health/Medical community
• Human and Social Services
• Community based organizations
• Business community
• Faith Based organizations
• Local government
• American Indian organizations/ associations
• Alaskan Native organization/associations
• Other
•

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3. Did your organization develop new collaborators as a result of the Digital Inclusion Corps Pilot?
If “NO” or “UNSURE” (#3) Skip
If YES (#3a)
What sectors do your new collaborators represent?
(PLEASE CHECK ALL THAT APPLY)
• Culture/Art/History
• Education: Pre K12
• Education: Higher Education
• Education: Workforce Development/Career Services
• Disability Services organizations
• Public Health/Medical community
• Human and Social Services
• Community based organizations
• Business community
• Faith Based organizations
• Local government
• American Indian organizations/ associations
• Alaskan Native organization/associations
• Other
4. Which demographic groups participated in the Digital Inclusion Corps Pilot Project?
(PLEASE CHECK ALL THAT APPLY)
•
Youth
•
Tribal communities
•
American Indian organizations/ associations
•
Alaskan Native organization/associations
•
Small/remote and underserved communities
•
Economically and socially disadvantaged populations
•
Developmental, mental and/or physically disabled populations
•
Women
•
Retired and older adults
•
Veterans
•
Rural residents
•
Urban and or suburban residents
•
Individuals with some difficulty with the English language and/or Non English speakers
•
Other

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5. Have you provided programming/services to these demographic groups before?
If “YES” (#5) Skip
If “NO” (#5a)
What new demographic groups did you engage through the Digital Inclusion Corps Pilot Project?
PLEASE CHECK ALL THAT APPLY
•
Youth
•
Tribal communities
•
American Indian organizations/ associations
•
Alaskan Native organization/associations
•
Small, remote and underserved communities
•
Economically and socially disadvantaged populations
•
Developmental, mental and/or physically disabled populations
•
Women
•
Retired and older adults
•
Veterans
•
Rural residents
•
Urban and or suburban residents
•
Individuals with some difficulty with the English language and or Non English speakers
•
Other

6. What activities did your organization undertake to address Digital Inclusion?
(PLEASE CHECK ALL THAT APPLY)
•
Provide digital literacy training at our facility
•
Provide digital literacy training off site in places convenient to community
members (i.e., senior homes, community centers, homeless shelters)
•
Develop tailored classes to meet specific needs (i.e. create email or social media
accounts, register for services/benefits/employment, attach documents to email, etc.)
•
Provide facilities, technology or internet access for community organizations
•
Provide facilities, technology or internet access for individuals
•
Respond to specific requests for technical assistance from individuals
•
Promote/secure home broadband services for eligible populations
•
Promote/secure affordable computing devices for eligible populations
•
Other
7. Overall, were participant groups digitally disconnected and/or did they lack digital literacy skills?
(Y/N/Unsure)
8. Did you provide opportunities for participants to provide feedback on activities?
If “NO” or UNSURE (#8) Skip
If “YES” (#8a)
• Survey (paper)
• Survey (online)
• Verbal to an organizational representative
• Other
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9. Did your organization develop a plan of action for future Digital Inclusion activities/goals?
(Y/N/Unsure)
If “NO” or UNSURE (#9) Skip
If “YES” (#9a)
Is there a timeframe for activities within the Digital Inclusion plan of action? (Y/N/Unsure)
If “NO” or UNSURE (#9) Skip
If YES (#9b)
What is the timeframe? 1 year/2 years/3 years/Other

10. Does your organization’s Digital Inclusion plan of action include metrics to measure outcomes
and/or progress? (Y/N/Unsure)
11. Did your organization develop or modify your Mission, Vision and/or Values statement regarding
Digital Inclusion?
If “NO” or UNSURE (#11) Skip
If YES (#11a)
Does your updated/new Digital Inclusion statement address:
Affordable, robust broadband internet service?
(Y/N/Unsure)
Internet-enabled devices that meet the needs of the user?
(Y/N/Unsure)
Digital literacy training?
(Y/N/Unsure)
Quality technical support?
(Y/N/Unsure)
Applications and online content designed to enable and encourage self-sufficiency,
participation and collaboration?
(Y/N/Unsure)

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ANCHOR INSTITUTION END OF PROJECT SURVEY
Please indicate choose the best answer for each statement: (Strongly Agree through Strongly Disagree)
1. My organization has engaged local partners in the Digital Inclusion goal setting process.

2. My organization has identified the community’s priority constituencies and their programmatic
needs.
3. My organization has used local personnel and developed customized resources/ models to achieve
our Digital Inclusion goals.

4. My organization offers programs, services and/or resources to address the community’s Digital
Inclusion needs.

5. My organization is an active contributor to problem solving Digital Inclusion issues in the
community.

6. As a community anchor institution, my organization has free access to a robust Digital Inclusion
resource repository.

7. My organization has access to field tested models designed to enhance Digital Inclusion in the
community.

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COMMUNITY PARTNERS PRE-PILOT DIGITAL INCLUSION PILOT PROJECT SURVEY
Individual Contact and Organizational Information
1. Confidentiality review and agreement to participate in survey activities
This is a confidential survey, unless otherwise required by law. Data from this survey will be reported in
aggregate. No one other than the researchers will know individual answers to this questionnaire, unless
otherwise required by law. Survey data will be used to assess the effect of digital inclusion activities lead
by museums/libraries that include participation from their community. Completing this survey will give
you the opportunity to share your experience with the project.
By checking the response below, you agree to participate and confirm you understand your participation in
the project is completely voluntary. You may decline altogether, or leave blank any questions you don’t
wish to answer. There are no known risks to participation beyond those encountered in everyday life.
I agree to participate in this confidential survey.

If YES, Continue
If NO, End Survey
2. What is the name of your organization?
3. What is your role within the organization? (i.e. senior leader, manager, staff, Digital Inclusion
Corps member)

4. Are you the point of contact/designee within your organization for the Digital Inclusion Corps
Pilot Project?
If YES, Continue
If NO, End Survey.
5. What is the formal mission of your organization? (Comment box)
6. Where is your organization located? (Alaska, Arizona, Minnesota, New Mexico, Oklahoma)
7. Do you serve federal or state recognized tribal groups?
(Y/N/Unsure)
8. My organization is:
The designated Anchor Institution for the Digital Inclusion Corps Pilot Project
A local collaborator/partner in the Digital Inclusion Corps Pilot Project

9. Will your organization participate in the Digital Inclusion Corps Pilot Project?
(Y/N/Unsure)
If “NO” “UNSURE” End survey

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10. What sector does your organization represent?
• Culture/Art/History
• Education: Pre K12
• Education: Higher Education
• Education: Workforce Development/Career Services
• Disability Services organizations
• Public Health/Medical community
• Human and Social Services
• Community based organizations
• Business community
• Faith Based organizations
• Local government
• American Indian organizations/ associations
• Alaskan Native organization/associations
• Other

11. What customer groups does your organization serve?
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Youth
Tribal communities
American Indian organizations/ associations
Alaskan Native organization/associations
Small, remote and underserved communities
Economically and socially disadvantaged populations
Developmental, mental and/or physically disabled populations
Women
Retired and older adults
Veterans
Rural residents
Urban and/or suburban
Individuals with some difficulty with the English language and/or Non English speakers
Other

12. What services does your organization provide to your customers:
(PLEASE CHECK ALL THAT APPLY)
• Education
• Employment
• Health and Wellness
• Social programming
• Cultural programming
• Advocacy
• Connecting customers with government services/benefits
• Housing services
• Digital literacy services
• Other

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13. My organization has partnered with (Anchor Institution Name Here) in the past year.
(Y/N/Unsure)
14. My organization uses the internet and online resources to meet our customers’ needs.
(Y/N/Unsure)
15. My organization provides access to the internet and technologies for use by our customers.
(Y/N/Unsure)
16. Most of the customers served by my organization have access to the internet at home.
(Y/N/Unsure)
17. Customers served by my organization have the skills needed to explore, create and communicate
in the digital world. (Y/N/Unsure)
18. I am familiar with the term Digital Inclusion and understand what it means to my customers.
(Y/N/Unsure)
19. My organization has participated in discussions to set priorities and goals for Digital Inclusion in
the community.
If “YES” (#11) Skip
If “NO” of “UNSURE” (#11a)
Would you participate in community discussions focusing on Digital Inclusion goals and
priorities if made available to you? (Y/N/Unsure)

20. The community understands the unique needs of our customers regarding access to the internet
and online resources.
If “YES” (#12) Skip
If “NO” of “UNSURE” (#12a)
Would you participate in discussions to provide input on the needs of your customers?
(Y/N/Unsure)
If “YES” (#12) Skip
If “NO” of “UNSURE” (#12b)
Would your customers participate in discussions to about their specific needs regarding
access and use of the internet and digital tools? (Y/N/Unsure)
21. My organization is familiar with programs/resources that connect our customers to the internet.
(Y/N/Unsure)
22. My organization has access to technical assistance and digital resources to address the needs of
our customers. (Y/N/Unsure)
23. My organization would participate in activities to improve the digital literacy skills of our staff.
(Y/N/Unsure)

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COMMUNITY PARTNER POST-PILOT DIGITAL INCLUSION PILOT PROJECT SURVEY:
1. Does your organization provide any new services to your customers as a result of the Digital
Inclusion Pilot program?
If “NO” or “UNSURE” (#1) Skip
If “YES” (#1a)
What new service(s) did you organization provide during the Digital Inclusion Pilot Project?
(PLEASE CHECK ALL THAT APPLY)
• Education
• Employment
• Health and Wellness
• Social programming
• Cultural programming
• Advocacy
• Connecting customers with government services/benefits
• Housing services
• Digital literacy services
• Other
2. My organization has partnered with (Anchor Institution Name Here) in the past year.
(Y/N/Unsure)
3. My organization uses the internet and new/additional online resources to meet our customers’
needs as a result of the Digital Inclusion Corps Project. (Y/N/Unsure)
4. My organization provides new opportunities for our customers to access the internet and interact
with technology as a result of the Digital Inclusion Corps project. (Y/N/Unsure)
5. Customers served by my organization have new skills needed to explore, create and communicate
in the digital world. (Y/N/Unsure)
6. I am familiar with the term Digital Inclusion and understand what it means to my customers as a
result of the Digital Inclusion Corps project. (Y/N/Unsure)
7. My organization participated in discussions to set priorities and goals for Digital Inclusion in the
community as a result of the Digital Inclusion Corps project. (Y/N/Unsure)
8. My community understands the unique needs of our customers regarding access to the internet
and online resources as a result of the Digital Inclusion Corps project. (Y/N/Unsure)
9. Did your organization participate in discussions to provide input on the needs of your customers
as a result of the Digital Inclusion Corps project? (Y/N/Unsure)
10. Did your customers participate in discussions about their specific needs regarding access and use
of the internet and digital tools as a result of the Digital Inclusion Corps project? (Y/N/Unsure)

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11. Did your organization learn about new programs/resources connect your customers to the internet
as a result of the Digital Inclusion Corps project? (Y/N/Unsure)
12. My organization has access to expanded technical assistance, programs and digital resources that
address the needs of our customers as a result of the Digital Inclusion Corps project.
(Y/N/Unsure)
13. My organization participated in activities to improve the digital literacy skills of our customers as
a result of the Digital Inclusion Corps project. (Y/N/Unsure)
14. My organization participated in activities to improve the digital literacy skills of our staff as a
result of the Digital Inclusion Corps project. (Y/N/Unsure)
15. Does your organization anticipate sustaining Digital Inclusion activities beyond Digital
Inclusion Corps Pilot Project? (Y/N/Unsure)

HCS NDIA-PAST Digital Inclusion Corps Pilot Project Surveys 2017, IMLS NLG, FY 16