Example instrument for Formative Reresearch (site selection questionnaire)

APPENDIX C

EXAMPLE TEMPORARY site selection questionnaire (Not FINAL)

OMB Control Number: 1220-0NEW

Expiration Date: TBD

CEO FORM Number: TBD

YouthBuild – Site Selection Questionnaire

INTRODUCTION

MDRC and its research partners Mathematica Policy Research and Social Policy Research Associates are conducting an evaluation of the YouthBuild program on behalf of the U.S. Department of Labor, Employment and Training Administration and the Corporation for National and Community Service. Currently, we are gathering some preliminary information about YouthBuild programs and would like to ask you a few questions about your specific program. The information that you provide will be used to help select a range of programs for the full evaluation.

We ask that your program director take a few minutes to fill out this questionnaire to help us better understand your program. The survey questions should take no longer than ten minutes to answer. This study will help us better understand how the YouthBuild program affects participants’ post-program employment and education outcomes. We also hope to better understand how the values and goals of YouthBuild are implemented in programs around the country. Individual responses will not be attributed to specific individuals or organizations. You are not required to respond to this information collection; however your assistance will help the Department of Labor to improve efforts to serve disadvantaged youth. Responses to this data collection will be used only for statistical purposes. The reports prepared from this questionnaire will summarize findings across all YouthBuild sites and individual forms will not be available to anyone outside the study team, except as required by law. Please see the last page of this survey for more detailed information.

Your participation in the YouthBuild evaluation will greatly contribute to the national debate about policies and practices designed to improve the well-being of disadvantaged youth. If you have any questions as you complete this questionnaire, please contact (NAME HERE) at Mathematica Policy Research at 1‑866‑XXX‑XXXX or XXX@mathematica-mpr.com.

First, we would like to know some basic information about the size and configuration of your YouthBuild program.

1. How many participants are currently enrolled in your program?

| | | | NUMBER OF PARTICIPANTS

1 □ This is our first year running a YouthBuild program and we have yet to enroll any youth.

2 □ We are not a new program but have not enrolled youth yet this year.

2. How many applicants do you expect will apply to your program between April 2011 and March 2012? (By apply, we mean youth who try to enroll in the program but who have not yet been determined to be eligible for the program.)

| | | | NUMBER OF APPLICANTS

1 □ We do not expect to receive any applications during this time.

3a. Do applicants under the age of 18 have to provide written assent to participate in the program?

1 □ Yes

0 □ No

3b. How do you obtain consent from a parent or guardian for applicants under the age of 18 to participate in the program?

1 □ Written consent form

2 □ Verbal consent by telephone

3 □ Electronic consent via email or text

4 □ We do not obtain consent

5 □ Other (Specify)

4 . Does your program have a Mental Toughness Orientation (MTO)?

1 □ Yes

0 □ No SKIP TO Q.8

5. (IF Q.4=Yes) How long is your MTO, in days?

| | | | NUMBER OF DAYS

6. (IF Q.4=Yes) On average, how many hours per day do candidates spend in MTO?

1 □ Less than 2 hours a day

2 □ Between 2 and 4 hours a day

3 □ Between 4 and 6 hours a day

4 □ Between 6 and 8 hours a day

5 □ More than 8 hours a day

7. (IF Q.4=Yes) How many applicants will be invited to participate in MTO this year?

| | | | NUMBER OF APPLICANTS

8. Approximately how many participants do you plan to enroll in your program between April 2011 and March 2012? (By enroll, we mean youth who complete MTO, if your program has it, and satisfy all other requirements in order to start your program.)

| | | | NUMBER OF PARTICIPANTS

9. What is the maximum number of applicants you could accept into your program between April 2011 and March 2012?

| | | | MAXIMUM NUMBER OF PARTICIPANTS

10. How many cohorts, or groups, do you expect to enroll into your program between April 2011 and March 2012?

1 □ One cohort

2 □ Two cohorts

3 □ More than two cohorts

4 □ We admit participants on a rolling basis

11. During which months of the year do you expect applicants to enroll in your program? (By enroll, we mean applicants who complete MTO, if you have it, and satisfy all other requirements in order to start your program.)

MARK ALL THAT APPLY

1 □ April 2011

2 □ May 2011

3 □ June 2011

4 □ July 2011

5 □ August 2011

6 □ September 2011

7 □ October 2011

8 □ November 2011

9 □ December 2011

10 □ January 2012

11 □ February 2012

12 □ March 2012

12. Including the time spent in MTO, how long does the average participant take to complete your YouthBuild program?

1 □ Less than 6 months

2 □ 6-12 months

3 □ 13-18 months

4 □ More than 18 months

The next few questions ask about the worksite(s) associated with your YouthBuild program.

13. Do you own the worksite(s)? If you have multiple worksites, do you own the primary worksite?

1 □ Yes SKIP TO Q.15

0 □ No

14. (IF Q.13=No) Who owns your worksite?

15. Do you manage the worksite(s)? If you have multiple worksites, do you manage the primary worksite?

1 □ Yes SKIP TO Q.17

0 □ No

16. (IF Q.15=No) Who manages this worksite?

17. How long has your program director had (her/his) job?

1 □ Less than 1 year

2 □ 1-3 years

3 □ 4-5 years

4 □ 6-10 years

5 □ More than 10 years

18. Which of the following best describes the organizational structure of your program?

MARK ONE ONLY

1 □ Independent organization

2 □ Part of larger group or agency

3 □ Charter school

4 □ Connected with One-Stop

5 □ Connected with AmeriCorps

6 □ Other (Specify)

19. Does your program use an Institutional Review Board?

1 □ Yes

0 □ No

Thank you for taking the time to answer our questions. We appreciate your willingness to participate in this preliminary step. The evaluation of the YouthBuild program will be conducted over the next few years and will include a more comprehensive survey of all DOL-funded grantees. In addition, a select number of grantees will be randomly selected to participate in a portion of the study that is designed to measure the impact of YouthBuild on participants’ outcomes. If your site is randomly selected for that portion of the study, we will contact you in the near future. Thank you again for your time!

Persons are not required to respond to this collection of information unless this survey displays a currently valid OMB control number (OMB xxxx-xxxx, expires xx/xx/xxxx). Responding to this questionnaire, which seeks to help the Department of Labor understand how YouthBuild programs are serving disadvantaged youth, is voluntary. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate to Eileen Pederson, U.S. Department of Labor, Employment and Training Administration, Office of Policy Development and Evaluation, Room N-5641, 200 Constitution Avenue, NW, Washington, DC 20210

Do NOT send the completed questionnaire to this address.