## 1 **AMERICORPS MEMBER SURVEY QUESTIONS**

**Survey Instructions** The Corporation for National and Community Service (CNCS), with its contractor [TBD] is conducting a study of the School Turnaround AmeriCorps program, a partnership between CNCS and the Department of Education. The purpose of the study is to learn about how AmeriCorps programs are being implemented and how they are helping schools improv e. You have been selected to complete a survey as part of the study. Your perspective is very important, so please answer honestly. Your participation in this study is completely voluntary. Refusing to participate will not involve any penalty or affect your [AmeriCorps status] in any way. It also will have no effect on your relationship with your school. It should take you approximately 30 minutes to complete the survey. Answer the questions based only on your experience [with your AmeriCorps program] [at your school] this year. All responses are anonymous and y our responses will be kept confidential to the extent provided by l aw. Under no circumstances will anyone from your [AmeriCorps program] [ school ] have access to any information that ca n be attribut able to you. The information you provide in the survey will be summarized with the information from other respondents and included in a report that will be shared with your AmeriCorps program and with CNCS. Please contact XXXX of XXXX, at XXX-XXX-XXXX or XXXX, if you have any questions regarding this research.

## 2 Note: If you serve at multiple schools, think about the school where you spend most of your time for questions that are specific to a school rather than the program overall. **1. In**  **which school(s) did you serve?**

**___________________________________________________________________________________________________ a.**  **If you served at multiple schools, where did you spend most of your time?___________________________________**
**2. If you served any** **where other than a school (ex. a fterschool program not on school grounds), where did you serve?** 

**___________________________________________________________________________________________________ 3.**  **For how many weeks/months did you serve at your school**  **(s) ?______**  **_____ weeks OR**  **_____ months**
**4. On average, how many hours per week did you serve**  **at your school (s)**  **?______**
**5. Did you**  **provide direct services to individual students or to the whole**  **classroom or school? (Check all that apply.)** 

__ AmeriCorps programming was targeted to individual students __ AmeriCorps programming supported the whole classroom __ AmeriCorps programming supported all students in the school **6. Did**  **you work with special populations**  **of students or students**  **with specific needs**  **? (Check all that apply.)**  ___ ELA (English Language Acquisition) / ELL (En glish Language Learner) / ESL ( English Second Language) ___ Low- performing in math ___ Low- performing in reading ___ At risk for dropping out ___ At risk for socio
- emotional pro blems ___ Students with disabilities ___ Other: ___________________________________________________________________________________________ **7. During the**  **first semester , w**  **hat did you do in your capacity as an AmeriCorps member ?**  **(Check all that apply.)**

___ Tutored in math ___ Tutored in reading ___ Tutored in other subjects ___ Mentored students individually ___ Provided wraparound services ___ Provided extended learning time ___ Worked with afterschool program ___ Provided graduation coaching ___ Organized family/community events ___ Taught classes ___ Other: _______________________________________

____________________________________________________ ___ Not Applicable – I did not serve during the first semester
**8. During the**  **second semester , what did you do**  **in your capacity as an AmeriCorps member? (Check all that apply.)**  ___ Tutored in math ___ Tutored in reading ___ Tutored in other subjects ___ Mentored students individually

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___ Provided wraparound services ___ Provided extended learning time ___ Worked wi th afterschool program ___ Provided graduation coaching ___ Organized family/community events ___ Taught classes ___ Other: ___________________________________________________________________________________________ ___ Not Applicable – I did not serve during the second semester
**9. What do you**  **consider to be the most important**  **school turnaround outcomes**  **over the next two years for**  **the students with**  **whom you worked**  **directly ?**  **(Check all that apply.)** ___ Enhanced academic achievement ___Improved grades ___Improved completion of assignments ___Increased motivation ___Increased self
- esteem ___ Improved attendance ___Improved socio
- emotional health ___Improved behavior ___Other. If other, please specify __________________ **10. Please fill in**  **the following table about s** **chool t**  **urnaround outcomes for the students you worked with directly.** As a group, did the students you worked with directly show improvement in these area this year ? If you marked “Yes,” what were the outcomes with the greatest degree of improvement among the students you worked with? Rank, with 1=Greatest improvement. Do not rank outcomes that you marked “No.” Enhanced academic achievement, as measured by interim progress or unit assessments ___Yes ___No Improved gra des ___Yes ___No Improved completion of assignments ___Yes ___No Increased motivation ___Yes ___No Increased self
- esteem ___Yes ___No Improved attendance ___Yes ___No Improved socio
- emotional health ___Yes ___No Improved behavior ___Yes ___No Other: __________________________ ___Yes ___No
**11. Please indicate**  **your level of agree**  **ment /** **disagree ment**  **with the following statements about your level of integration at the school.**  **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** a. Teachers in this school share and discuss instructional practices with me . b. Teachers in this school share and discuss behavioral management strategies with me . c. Teachers in this school discuss their expectations for students with me . d. Teachers and I collaborat e successful ly in support ing students.

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e. I’m integrated into regular staff meetings and communication. f. The principal and/or school leadership team communicates a clear vision of turnaround to me . g. The principal and/or school leadership team monitors performance and progress of implementation of turnaround activities at this school. **12. For this**  **school year, please indicate how satisfied you are with each of the elements listed below: Very**  **Dissatisfied Dissatisfied**  **Satisfied Very**  **Satisfied Not** 

**Applicable** a. Communication and collaboration between the teachers and myself b. Communication and collaboration between the school leadership and myself c. Training and support provided by grantee organizations. d. Training and support provided by teachers in this school **e.** My p lacement in meaningful service activities **f.** Referral of students to me for services **g.** Matching me with students in need of academic strengthening and social/emotional supports **h.** Sharing of outcome data by the school/district to review and assess student progress **i.** My overall experience in supporting school turnaround in this school **j.** This service experience in preparing me for my future education and/or career plans **13. In your opinion, how successful**  **were your activities and contributions in the following**  **areas this year**  **? (Mark one response in each row.)**  **Very Unsuccessful**  **Somewhat**

**Unsuccessful Somewhat** 

**Successful Very** 

**Successful Not** 

**Applicable** a. Overall success of the AmeriCorps program b. I mproving the academic achievement of students I worked with directly, as measured by interim progress or unit assessments c. I mproving the socio
- emotional health of students I worked with directly d. I mproving school climate
e. I mproving the school’s capacity to implement its turnaround model **14. Prior**  **to serving in AmeriCorps, t o what extent**  **we re you**  **interested in pursuing a career as a teacher?**  [ ] Not interested [ ] Might be interested [ ] Interested [ ] Strongly interested **15. Prior to serving in AmeriCorps, to what extent we**  **re you interested**  **in pursuing a career in another capacity related to**  **education or youth development?** [ ] Not interested [ ] Might be interested [ ] Interested [ ] Strongly interested Please explain_______________________________________________________________________

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**16. At this point in time,**  **to what extent a**  **re you interested in pursuing a career as a teacher?** [ ] Not interested [ ] Might be interested [ ] Interested [ ] Strongly interested **17. At this point in time** **, to what extent a**  **re you interested in pursuing a career in another capacity related to education or youth development?**  [ ] Not interested [ ] Might be interested [ ] Interested [ ] Strongly interested Please exp lain_______________________________________________________________________ **18. Why did you join this AmeriCorps program?** 

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________ **19. What did you hope to accomplish this year? Did the experience meet your expectations? Why or why not?** 

____________________________________________________________________________________________________________

___________________________________________ _________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________ **20. What worked pa**  **rticularly well this year at your school? Why do you think it worked well?**

____________________________________________________________________________________________________________

_________________________________________________________________________ ___________________________________

____________________________________________________________________________________________________________

____________________________________________________________________ **21. What did not work well this year at your sch**  **ool? Why do you think that was the case? What suggestions do you have for improving the program for next year?** 

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

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## 6 **MEMBER EVALUATION OF IMPROVEMENT**  **Thinking about the student whose last name is closest to the beginning of the alphabet, and the student whose last name is closest to the end of the alphabet, please complete the following for those two**  **students. 22.**  **Since the beginning of the AmeriCorps program**  **, t o what extent has your student changed**  **his or her behavior in terms of:**  **Student #1:** Significant Decline Moderate

Decline No Change Moderate Improvement Significant

Improvement Did not Need to

Improve a. Turning in his/her homework on time. b. Completing homework to your satisfaction.
c. Participating in class. d. Volunteering (e.g., for extra credit or more responsibilities).
e. Attending class regularly. f. Being attentive in class. g. Coming to school motivated to learn. h. Getting along well with other students. **Student #2:** Significant Decline Moderate

Decline No Change Moderate Improvement Significant

Improvement Did not Need to

Improve a. Turning in his/her homework on time. b. Completing homework to your satisfaction.
c. Participating in class. d. Volunteering (e.g., for extra credit or more responsibilities).
e. Attending class regularly. f. Being attentive in class. g. Coming to school motivated to learn. h. Getting along well with other students.