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 measuresiin 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 volunteer
 RSVP 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 receiving 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 

 White 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 family 
 veteran 

 family of veteran 

14. What 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

 Widowed

 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 other 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 year 
17. Please think about your life-as-a-whole. Taking all things together, how satisfied are you with your life-asa-whole these days? [Check one box] 

 completely satisfied 

 very satisfied 

 somewhat satisfied 

 not very satisfied 

 not at all satisfied 

18. Would 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 personal 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 also 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 Caregivers 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): 
 White 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 

never
17. 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
Appendix A. Source of survey item as related to the Health and Retirement Surveyii

Item Construct HRS section / Q# Notes: 

9 Date Of Birth Will be used to calculate age

10 Gender Core Section, Section A, MA008 

11 Race Core Section, Section B MB091M

12 Hispanic Core Section, Section B , B028

13 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 

Performance Measure

14 Highest Grade Completed Core Section, Section B, MB014

15 Marital Status Core Section, Section B, MB063

16 Number of volunteer hours Core Section, Section G, G086, 

G195-7

17 Overall (global) well-being: 

Life satisfaction 

Core, section B, B000 Campbell et al (1976) 

18 Self reported health Core, section C, C001 Standard survey item 

19-20 Loneliness Core, section LB*, Q20a,i Hughes, M. E., Waite, L. 

J., Hawkley, L. C., & 

Cacioppo, J. T. (2004) 

21 Close ties with friends Core, section LB, Q18 Multiple sources 

22-23 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/