ACL CLAS 2 – Grantee Survey 

[INTRODUCTION TEXT FOR LANDING PAGE]

Welcome! This brief survey is designed to gather your input about experiences with the 

Administration for Community Living (ACL) related to diversity, equity, and inclusion (DEI). The 

questions pertain specifically to your organizational experiences in partnership with ACL. We 

expect this survey will take no more than 10 minutes of your time.

[SCREENING QUESTIONS]

S1. Please indicate the most appropriate category to describe your organization. [CHECK 

ALL THAT APPLY; REQUIRE RESPONSE]

 Community-based organization

 National advocacy group

 Nonprofit organization

 Area Agency on Aging

 State or local government

 Higher education entity

 Tribal Organization

 Other: 

_____________________

[IF CHECKED, REQUIRE 

RESPONSE WITHIN 50 

CHARACTER TEXT FIELD]

S2. Please describe your role within your organization. [CHECK ALL THAT APPLY; REQUIRE 

RESPONSE]

 Administrator/organization 

leader

 Manager/team leader

 Clinician

 Service coordinator

 Other: _____________________ [IF CHECKED, REQUIRE 

RESPONSE WITHIN 50 

CHARACTER TEXT FIELD]

S3. What population does your organization primarily serve? [CHECK ALL THAT APPLY; 

REQUIRE RESPONSE]

 Older adults

 Older adults with disabilities

(age 65+)

 People with disabilities 

(between ages 18 and 64)

 Children with disabilities (under 

age 18)
ACL CLAS 2 – Grantee Survey 

 Caregivers/families

 Other: _____________________ [IF CHECKED, REQUIRE 

RESPONSE WITHIN 50 

CHARACTER TEXT FIELD]

S4. Please specify how long your organization has worked with ACL. [CHECK ONLY ONE; 

REQUIRE RESPONSE]

 <1 year

 1-2 years

 3-5 years

 6-10 years

 More than 10 years

S5. What has your organization’s role been in working with ACL? [CHECK ALL THAT APPLY; 

REQUIRE RESPONSE]

 Current grantee/sub-grantee 

 Previous grantee/sub-grantee 

 Other: _____________________ [IF CHECKED, REQUIRE 

RESPONSE WITHIN 50 

CHARACTER TEXT FIELD]

S6. Has your organization engaged in any diversity, equity, and inclusion activities (e.g., 

language support, cultural competence training, diverse hiring practices) in the past two

years? [ALLOW ONLY ONE ANSWER; REQUIRE RESPONSE]

 Yes [IF YES, PROCEED TO 

MAIN SURVEY]

 No [IF NO, DISCONTINUE 

AND THANK 

PARTICIPANT]

[SURVEY QUESTIONS]

The following questions explore the types of diversity, equity, and inclusion (DEI) activities in 

which your organization may have engaged.

DEI PRIORITIES

Q1. Thinking about diversity, equity, and inclusion

(DEI), what marginalized populations does your 

organization serve? [CHECK ALL THAT APPLY]

 Older adults
ACL CLAS 2 – Grantee Survey 

 People with disabilities or 

functional impairments

 People with diverse gender 

identity

 Sexual orientation

minorities

 Immigrants

 Non-native English 

speakers

 Racial or ethnic minority 

populations

 Religious minority

populations

 Low-income/people living 

in poverty

 People with diverse 

learning needs or low 

literacy

 People living in rural 

communities

 Veterans

 Other: 

_____________________

[IF 

CHECKED, 

REQUIRE 

RESPONSE 

WITHIN 50 

CHARACTER 

TEXT FIELD]

Q2. How have you identified that your program 

serves marginalized populations? [CHECK ALL 

THAT APPLY]

 Participants are asked 

demographic questions at 

intake/program 

enrollment

 Program location only 

serves a specific 

population (e.g., everyone 

in service area is rural)
ACL CLAS 2 – Grantee Survey 

 Evaluation findings from 

prior research effort

 Evaluation of data 

collected through program 

Needs Assessment 

 Other: 

_____________________

[IF 

CHECKED, 

REQUIRE 

RESPONSE 

WITHIN 500 

CHARACTER 

TEXT FIELD]

Q3. In which ways have you identified needs among 

the population you serve? [CHECK ALL THAT 

APPLY]

 Participant interview, 

focus group, or survey

 Observation 

 Evaluation findings from 

prior research effort

 Review of Needs 

Assessment data

 Feedback from program 

enrollees

 Other: 

_____________________

[IF 

CHECKED, 

REQUIRE 

RESPONSE 

WITHIN 500 

CHARACTER 

TEXT FIELD]

Q4. In what types of DEI activities has your 

organization been engaged in the past two 

years? [CHECK ALL THAT APPLY]

Organizational Structure, Hiring, and Training

 Organizational leaders 

promote DEI priorities

 Recruit diverse 

organizational leadership 

and/or staff
ACL CLAS 2 – Grantee Survey 

 Host cultural competence 

or other DEI-focused 

training for organizational 

leadership and/or staff

 Translate written 

documents

 Use professional 

interpreters (including 

CART services)

 Establish organizational 

policy or practice to assess 

preferred language of 

service recipients at intake

 Establish organizational 

accountability process to 

ensure adherence to DEI 

priorities

 Reassess existing DEI 

trainings toward 

continuous improvement

Service Provision

 Language assistance (e.g., 

interpreters) for nonnative English speaker

service recipients

 Language assistance for 

service recipients with low 

vision (e.g., Braille)

 Language assistance for 

service recipients with 

hearing impairment (e.g., 

American Sign Language)

 Translated materials for 

non-native English speaker

service recipients

 Plain language materials 

for service recipients

Data Management

 Collect demographic data 

among organization’s 

service recipients to 

understand population

[IF 

CHECKED, 

REQUIRE 

Q2a]
ACL CLAS 2 – Grantee Survey 

 Analyze demographic data 

collected to determine 

whether services are 

aligned to population 

needs

 Conduct community 

assessments to understand 

local service needs

 Report findings of data 

collection and assessments 

to the public 

Community and Individual Partners

 Establish community 

partnerships with diverse 

populations and/or local 

organizations

 Create conflict resolution 

or grievance process for 

service recipients who 

need to report when 

services do not align with 

their cultural or linguistic 

needs

 Communicate 

organization’s 

commitment to DEI 

through media or other 

public-facing channels

 Other: 

_____________________

[IF 

CHECKED, 

REQUIRE 

RESPONSE 

WITHIN 250 

CHARACTER 

TEXT FIELD]

Q5. Please list the types of demographic data you 

collect among your service recipients.

[RESPONSE 

WITHIN 1000 

CHARACTER 

TEXT FIELD]

Q6. In what ways is your organization measuring 

success with addressing your DEI priorities?

[CHECK ALL THAT APPLY]
ACL CLAS 2 – Grantee Survey 

 Organizational leadership 

survey or interview

 Organizational staff/team 

survey or interview

 Service recipient survey or 

interview

 Technical assistance 

feedback 

 Website or publication 

feedback

 Social media responses

 Research or advocacy 

feedback

 Recruitment and hiring 

feedback

 Other: 

_____________________

[IF 

CHECKED, 

REQUIRE 

RESPONSE 

WITHIN 250 

CHARACTER 

TEXT FIELD]

Q7. What are your greatest challenges in addressing 

your organization’s DEI priorities?

[OPEN TEXT 

FIELD, LIMIT 

1000 

CHARACTERS]

Q8. How has ACL supported your organization in 

addressing DEI priorities in the past two years?

[OPEN TEXT 

FIELD, LIMIT 

1000 

CHARACTERS]

Q9. What could ACL do to better support your 

organization’s DEI priorities? 

[OPEN TEXT 

FIELD, LIMIT 

1000 

CHARACTERS]

Q10. What other recommendations do you have for 

your interactions with ACL related to DEI 

priorities? 

[OPEN TEXT 

FIELD, LIMIT 

1000 

CHARACTERS]