Colorado Campus Compact - UCAN Serve Evaluation - Community Strengthening Survey

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Colorado Campus Compact UCAN Serve AmeriCorps Program

Community Strengthening Survey ~ Agency Questionnaire

Demographics

About your organization

1.	Date: (mm/dd/yy)
2.	Please identify your State: Arizona Colorado Utah New Mexico
3.	Please identify your University/College Site:
		Arizona State University Brigham Young University College of Eastern Utah Colorado Christian University Colorado College Colorado Mountain College Colorado State University Colorado State University at Pueblo Dixie State College Fort Lewis College Front Range Community College Johnson & Wales University Lamar Community College LDS Business College Mesa Community College Morgan Community College Naropa University Red Rocks Community College Regis University	Salt Lake Community College San Juan College Snow College Southern Utah University Trinidad State Junior College University of Colorado at Boulder University of Colorado at Colorado Springs University of Colorado at Denver & Health Sciences Center University of Denver University of New Mexico-Gallup University of Northern Colorado Utah College of Applied Technology University of Utah Utah State University Utah Valley State College Weber State University Western State College Westminster College Other
4.	Your Agency's Name:
5.	Please describe your agency’s location: Urban Rural
6.	Please indicate the categories which your agency serves (check all that apply)
		AIDS Arts & Cultural Enrichment Criminal Justice Disability Environment Gay, Lesbian & Bisexual Government & Politics Youth	Health Homelessness & Hunger Information & Referral International Affairs Mental Health Seniors Women Other (List)

1.	How many people work at your agency per week? (Please DO NOT count AmeriCorps members): people
2.	How many hours do these people at your agency work per week? (i.e. total person hours per week) total person hours per week
3.	How many members of the community are currently served by these people per week? community members served per week
4.	How many NEW volunteers were recruited into your agency per year? (Please DO NOT count new volunteers recruited by AmeriCorps members) New Volunteers Volunteers
5.	Please check or list ALL specific examples of direct services provided to your agency or projects completed by the UCAN Serve AmeriCorps member(s) in the past year:
	Recruiting and managing non-AmeriCorps volunteers Developing community-strengthening activities Assisting with volunteer recruitment and support	Assisting with activity planning for community events Assisting with interagency collaboration and service coordination Assisting with information distribution Other examples: (Please list below)

6.	Please list the various training sessions and orientation sessions your agency has provided to the UCAN Serve AmeriCorps members.

7.	How many UCAN Serve AmeriCorps member(s) work at your agency per week? AmeriCorps Members
8.	How many hours do AmeriCorps member(s) work per week? (i.e. total person hours per week)
9.	How many members of the community are served per week by AmeriCorps members? (Please DO NOT count community members served by Non-AmeriCorps members) Community members
10.	How many NEW volunteers have been recruited by AmeriCorps members this year? (Please DO NOT count volunteers recruited by Non-AmeriCorps members) New volunteers

Agency Satisfaction with AmeriCorps Members

Please place a check mark in the box that most closely reflects your answers to the questions below according to the following rating scale:

1 = Strongly Disagree,

2 = Disagree,

3 = Neutral,

4 = Agree,

5 = Strongly Agree,

n/a= Not Applicable

Please answer all of the following questions rating each of the following statements based on your personal experiences/observations at your agency over the past year:

Agency Satisfaction Rating
1.	The UCAN Serve AmeriCorps member(s) were available when support was needed.	1 2 3 4 5 n/a
2.	The UCAN Serve AmeriCorps member(s) were quick to respond when the agency needed help.	1 2 3 4 5 n/a
3.	The UCAN Serve AmeriCorps member(s) completed tasks on time.	1 2 3 4 5 n/a
4.	The UCAN Serve AmeriCorps member(s) completed everything they said they would do.	1 2 3 4 5 n/a
5.	The UCAN Serve AmeriCorps member(s) were courteous.	1 2 3 4 5 n/a
6.	The support provided by the UCAN Serve AmeriCorps member(s) met my expectations.	1 2 3 4 5 n/a
7.	The UCAN Serve AmeriCorps member(s) helped foster positive partnerships between our agency and the community.	1 2 3 4 5 n/a
8.	Overall, I am satisfied with the UCAN Serve AmeriCorps member(s) at my agency.	1 2 3 4 5 n/a
9.	This agency is interested in working with UCAN Serve AmeriCorps member(s) in the future.	1 2 3 4 5 n/a
Capacity Building Rating
10.	The UCAN Serve AmeriCorps member(s) helped increase the number of services the agency was able to provide this past year compared to the year before.	1 2 3 4 5 n/a
11.	The UCAN Serve AmeriCorps member(s) helped increase the quality of services offered by the agency in the past year compared to the year before.	1 2 3 4 5 n/a

	Please include any additional comments or clarifications (below):
	Please describe any challenges you encountered with the UCAN Serve AmeriCorps member(s) or with their affiliated group(s) (e.g. College/University Site Coordinator, CCC, CNCS, etc.)?
	Please estimate the monetary value of the services provided by the CCC AmeriCorps member(s) to your agency: $

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