**Senior Corps Survey**

**I. Survey** 

**goals** The purpose of CNCS is to provide grantees with a unified performance measure data collection instrument that will facilitate both data collection and analysis. This survey will provide performance measures that pertain to CNCS agency and Senior Corps priority performance measures i in the following areas:  Independent Living  Respite Care  Veterans  Volunteer Experience **II. Survey**

**scope** Grantees will collect data for the following volunteers , clients and caregivers :  FGP volunteer

 SCP volunteer

 SCP client

 Caregiver of a SCP client

 RSVP volunteer (optional)

 RSVP client

 Caregiver of a RSVP client Volunteers, clients and caregivers may refuse to answer some or all of the survey questions. Grantees may report refusals to answer survey questions by volunteers, clients and caregivers as completed questions. **III. Survey**

**content** 1. Program sponsor (grant number to be filled in by sponsor) 2. Name (of volunteer, client or caregiver) 3. Today’s date 4. Check one FGP volunteer
SCP volunteer SCP client Caregiver of a SCP client
RSVP volunteerRSVP client Caregiver of a RSVP client
5. If you are a FGP, SCP or RSVP volunteer: when did you begin volunteering with Senior Corps? month and year 6. If you are a FGP, SCP or RSVP volunteer: how many hours did you volunteer last month? 7. If you are a SCP or RSVP client: when did you start receiv ing services from SCP or RSVP ? month and year 8. If you are a caregiver of a SCP or RSVP client: when did the person you are caregiving for start receiving services from SCP or RSVP ? month and year 9. DOB 10. Gender male female 11. Do you consider yourself primarily W hite Caucasian Black/ African American American Indian or Alaskan Native Asian Native Hawaiian, or Pacific Islander other
12. Do you consider yourself Hispanic or Latino Yes No Don’t Know or refuse to answer

13. Veteran Status [Check all that apply] active duty military familyveteran family of veteran
14. Wh at is the highest grade of school or year of college you completed no formal education Grades 1
- 11 Grade 12 (High School Diploma or GED) Years 13
- 15 (Some College) Grade 16 (Bachelors Degree/ College Grad) 17+ (Post College) Other Don’t Know or refuse to answer

15. Are you currently married, have a partner as if married, separated, divorced, widowed, or never married? Married Annulled Have partner Separated Divorced Wi dowed Never Married Other or Refuse to answer
16. “How many hours did you spend in the past 12 months doing volunteer work for religious, educational, health
- related or oth er charitable organizations” including your volunteer time with FGP, SCP and RSVP. 0 hours a year 1
- 50 hours a year 51
- 100 hours a year greater than 100 hours a year17. Please think about your life
- as - a-whole. Taking all things together, how satisfied are you with your life
- as a -whole these days? [Check one box] completely satisfied very satisfied somewhat satisfied not very satisfied not at all satisfied 18. Wo uld you say your health is excellent, very good, good, fair, or poor? [Check one box] excellent very good good fair poor 19. How much of the time do you feel that there are people you feel close to? [Check one box] Often Some of the time Hardly ever or never 20. How much of the time do you feel that you lack companionship? [Check one box] Often Some of the time Hardly ever or never 21. How many of your friends would you say you have a close relationship with? Please write a number in the box
Please indicate how much you agree or disagree about each of the following statements 22. I can do just about anything I really want to do Strongly disagree Somewhat disagree Slightly disagreeSlightly agree Somewhat agree Strongly agree 23. I can do the things that I want to do Strongly disagree Somewhat disagree Slightly disagree Slightly agree Somewhat agree Strongly agree
**IV. Survey**

**privacy** Grantees will maintain survey records in a secure location for the period of the grant. Grantees may be asked to provide this information to a secure data base, as part of a Senior Corps Evaluation. The Senior Corps Evaluation will not release any person al information to anyone, including the grantee. The Senior Corps Evaluation vendor will release only de
- identified data to CNCS. The Senior Corps Evaluation vendor will also release summery data to the grantees. The Senior Corps Evaluation vendor may al so release de
- identified data to appropriate research requests that are part of an appropriate data sharing request. Senior Corps grantees will be asked to provide the following summary data to CNCS as part of the PPVA.
1. Program sponsor (grant number to be filled in by sponsor) 2. Number of FGP volunteers enrolled and the number completing the survey. 3. Number of SCP volunteers enrolled and the number completing the survey 4. Number of SCP clients served and the number completing the survey. 5. Number of Ca regivers of SCP clients served and the number completing the survey. 6. Number of RSVP volunteers enrolled and the number completing the survey. 7. Number of RSVP clients served and the number completing the survey. 8. Number of Caregivers of RSVP clients served and the number completing the survey. 9. Average age of volunteer 10. Number of volunteers who are women 11. Number of volunteers who self
- report as (may answer more than one):W hite Caucasian Black/ African American American Indian or Alaskan Native Asian Native Hawaiian, or Pacific Islander other
12. Number of volunteers who self
- report as Hispanic or Latino
13. Number of volunteers who self
- report as active duty military family veteran family of veteran 14. Number of clients who self
- report as active duty military family veteran family of veteran
15. Number of caregivers of clients who self
- report as active duty military family veteran family of veteran 16. Number of clients and caregivers who report the following: How much of the time do you feel that there are people you feel close to? On enrollment After 1 year of service After two years of

service Three or more

years Often Some of the time Hardly ever or never17. Number of clients and caregivers who report the following: How much of the time do you feel that you lack companionship? On enrollment After 1 year of service After two years of

service Three or more

years Often Some of the time Hardly ever or never 18. How many of your friends would you say you have a close relationship with? Please provide averages for the following groups: On enrollment After 1 year of

service After two years

of service Three or more

years Average number of friends would you say you have a close relationship with?

19. Volunteer response to “ I can do just about anything I really want to do” On enrollment After 1 year of

service After two years of

service Three or more

years Strongly disagree Somewhat disagree Slightly disagree Slightly agree Somewhat agree Strongly agree
20. Volunteer response to “ I can do the things that I want to do” On enrollment After 1 year of

service After two years of

service Three or more

years Strongly disagree Somewhat disagree Slightly disagree Slightly agree Somewhat agree Strongly agree**Ap pendix A** **. Source of survey item as related to the Health and Retirement Survey**  **ii Item**  **Construct HRS section / Q#**  **Notes:** 9 Date Of Birth Wi ll be used to calculate age 10 Gender Core Section, Section A, MA008 1 1 Race Core Section, Section B MB091M 1 2 Hispanic Core Section, Section B , B028 1 3 Veteran Not the best match. HRS Core Section, Section B, Respondent Information, MB035 Have you ever served in the active military of the United States? There are additional questions on veterans benefits This question is not designed for the HRS analysis, but is more for the Veterans Pe rformance Measure
1 4 Highest Grade Completed Core Section, Section B, MB014 1 5 Marital Status Core Section, Section B, MB063 1 6 Number of volunteer hours Core Section, Section G, G086, G195
- 7 1 7 Overall (global) well
- being:

Life satisfaction Core, section B, B000 Campbell et al (1976) 1 8 Self reported health Core, section C, C001 Standard survey item 1 9
-20 Loneliness Core, section LB*, Q20a,i Hughes, M. E., Wa ite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004) 2 1 Close ties with friends Core, section LB, Q18 Mu ltiple sources 2 2
-2 3 General Self
- efficacy /

Personal Mastery Core, section LB, Q23a,e Pearlin, L. I., & Schooler, C. (1978).

i http://www.nationalservice.gov/about/focus_areas/index.asp ii http://hrsonline.isr.umich.edu/