Partnership and Collaboration Survey 10/6/2014 Page 1 Form A pproved OMB No.__________ Exp. Date:_________ Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. T he OMB control number for this project is_____. P ublic reporting burden for this collection of information is estimated to average __ mi nutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the colle ction of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CNCS Reports Clearance Officer, 1201 New York Avenue, NW, Washington, DC 20525. 

## PARTNERSHIP AND COLL **ABORATION SURVEY** Thank you for agreeing to participate in this survey about the relationships between organizations whose mission is making positive change in your community
. The survey asks questions about the connections between yo ur organization and other organizations in your community
. The findings from this study will help the Corporation for National and Community Service ( CNCS ) better understand the value of networks in making positive change and disseminate best practices about collaboration and partnerships to organizations and communities across the country
. CNCS is the federal agency that promotes national service and volunteering in communities across the country. Your input is important
. Y our participation in this survey is voluntary. There are no penalties or consequences to you or your organization for not participating. You can choose to stop the survey at any time, or not answer a question, for whatever reason. If you stop the survey, at your request, we will destroy the survey. You may ask any questions that you have before, during, or after you complete the survey. Contact information for questions is listed below
. The survey will take approximately **30** minutes to complete
. Itis being administered by ICF International, in collaboration with CNCS. Benefits : Your participation will not result in any direct benefits to you. However, your input will help to provide a better understanding of the systems and networks making posi tive change in American communities. Risks : This survey poses little risks to you and/or your organization. *PRIVACY ACT NOTICE: The Privacy Act of 1974 (5 U.S.C § 552a) requires that the following notice be provided to you: The information requested in the Social Network Analysis Survey Form is collected pursuant to 42 U.S.C 12592 and 12615 of the National and Community Service Act of 1990 as amended, and 42 U.S.C. 4953 of the Domestic Volunteer Service Act of 1973 as amended, and 42 U.S.C. 12639. Pur poses and Uses
- The information requested is collected for the purposes of assessing how and to what extent grantees develop organizational capacity and relationships , as part of a longer term research agenda to evaluate AmeriCorps’ impact on the communities it serves. CNCS also will collect information from grantee partners, which are integral in engaging and serving client communities. Routine Uses
- Routine uses may include disclosure of the information to federal, state, or local agencies pursuant to lawfully authorized requests. The information may also be provided to appropriate federal agencies and Department contractors that have a need to know the information f or the purpose of assisting thePartnership and Collaboration Survey 10/6/2014 Page 2

Department’s efforts to respond to a suspected or confirmed breach of the security or confidentiality or information maintained in this system of records, and the information disclosed is relevant and unnecessary for the ass istance. The information will not otherwise be disclosed to entities outside of the Corporation for National and Community Service without prior written permission. Effects of Nondisclosure
- The information requested is not mandatory.

Contact information : If you have any concerns about completing this survey or have any questions about the study, please contact Dr. Bhuvana’s Sukumar at XXXX@icfi.com or XXX
-XXX
-XXXX. Please click the "I CONSENT" box below t o proceed to the survey.

 I CONSENT  I DO NOT CONSENT
Please verify the following information: **Your Name:**  **Your email address: Your telephone:**  **Organization name: List any other names your organization may be known by:**  **Organization address:**
1. Approximately h ow many full
- time equivalent employees are at your organization ?  1
- 4  5
- 9  10
- 19  20
- 99  100
- 499  500 or more 2. How long has your organization worked in the community or communities it currently serves?  Less than 1 year  1
- 5 yrs.  6
- 10 yrs.  10
- 20 yrs.  20+ years
3. How long have you worked for the organization?  Less than 1 year  1
- 5 yrs.  6
- 10 yrs.  10
- 20 yrs.  20+ years 4. What is your primary role in the organization?  Head, e.g. Executive director, President, CEO  Office or program director  Office or program staff  Other: _____________________Partnership and Collaboration Survey 10/6/2014 Page 3

5. How long have you been in your current role?  Less than 1 year  1
- 5 yrs.  6
- 10 yrs.  10
- 20 yrs.  20+ years 

### 6. **Organization sector:**

 Private, for
-profit business  Public, government organization, office or agency  Non
-profit organization  Religious or other spiritual organization  School (K
- 12 )  College or university  Other: ________________________ If your response to question #6 is not Private , for
-profit business please answer question #7 : 

### 7. How would you classify the work your organization does? Select all that apply.  Animal
-related  Arts, culture, humanities  Civil rights, social action and advocacy  Community development, Business and Industry  Crime and Legal  Diseases, Disorder, and Medical Disciplines  Education  Employment  Environment  Food, Agriculture and Nutrition  Health care  Housing  Human Services  International, Foreign Affairs and National Security  Mental Health, Substance Abuse  Mutual, Membership Benefit (eg. Insurance)  Philanthropy, Voluntarism and Grantmaking  Public Safety, Disaster Services  Public, Society Benefit  Recreation and Sports  Religion  Science and Technology  Social Science  Youth development  Other:

________________________________ 8. Which focus areas are targeted by your organization? Select all that apply
.  Education (eg. tutoring, literacy, adult education)  Health (eg. nutrition, access to care, prevention, awareness)  Services to veterans and/or military families  Environment (eg. education on environmental issues, land conservation, energy conservation, ecosystem development/mainte nance)  Disaster services ( eg. disaster education, preparation, mitigation, response)  Economic opportunity ( eg. housing services, employment counseling, job training)  Other, please specify: ____________________________________ 9. How much is your organization actively involved in [ Auto
- filled by survey program]? a. Not at all active b. Somewhat active c. Active d. Very active e. Don’t knowPartnership and Collaboration Survey 10/6/2014 Page 4



### 10. Which of the f

ollowing coalitions, workgroups or committees are you currently activel y involved with?  Group A  Group B  [ Additional Groups
- Auto
- filled by survey program 

### ]  Other (please specify): _______________  Our organization is not actively involved with any of these
11. The following organizations in your community have been identified as being involved in addressing [ Auto - filled by survey program] or Service [ Auto
- filled by survey program] . Please check all of the organizations that your organization has a relationship with to this end
. Having a relationship could mean you share a funding source, coordinate services, conduct training together, among others. These should be answered from an organizational perspective. Organizatio n A: Yes No Organization B : Yes No Organization C : Yes No 12. For organizations you indicated you have a relationship with , please answer the following questions.

How many years have you worked with the organization? What type of

relationship do you have? Check all that apply. Note:

- **Resources** means working together to develop or utilize financial or in
- kind resources, such as providing or receiving funding, sharing funding sources, sharing fiscal management, sharing facility or office space.

**- Managem**  **ent** means working together to develop or imp lement management functions, such as fiscal management, record
- keeping, or How strong is your relationship? How valuable is the relationship in addressing [Focus area X]? Has the

relationship been formalized through any official agreement, such as a Memorandum of Understanding ?Partnership and Collaboration Survey 10/6/2014 Page 5 IT systems

- **Organizational** means designing programs together, assessing programs, training staff, advertising or outreach

- **Service provision**  means working together to provide dire ct services , such as coordinating activities, giving or receiving referrals Org. A L e s s th an 1 ye ar

1 t o 5 ye ar s 6 t o 1 0 ye ar s 1 0 t o 2 0 ye ar s 2 0 + ye ar s D o n ’ t k no w **Resources**

**Managem ent**  **O rganizational**  **Service provision**  O th e r D o n ’ t Kno w N o t s tr o ng

N e i th e r s tr o n g no r weak S o me wh at s tr o n g V e ry s tr o ng D o n ’ t k no w N o t v a luab l e

N e i th e r v a l uab l e nor not valuable S o me wh at valuable V e ry v a l uab l e D o n ’ t k no w Y e s

N o D o n ’ t k no w

Org. B Org. C 13. Select up to the 7 organizations with wh om you communicate with most frequently. O rg an i z ati o n A O rg an i z ati o n B Organization C [Continue list of all organizations marked in question 11]
14. Consider the organizations you work with to address [Focus area X]
. a. How often do the organizations in your community work together to address this issue? Hardly ever Occasional

ly Neutral Frequently Almost always Don’t

Know

b. How effective do you think the organizations in your community are at addressing the issue? Very ineffective Ineffective Neutral Effective Very Effective Don’t

KnowPartnership and Collaboration Survey 10/6/2014 Page 6

[IF THE RESPONDENT SELECTS EFFECTIVE OR VERY EFFECTIVE, to 14a then ASK THE FOLLOWING:] 

### What individual and community level outcomes do you think are realized through the collaborative and partnership activities among organization in your community?

15. What additional types of organizational interactions or relationships do you think are necessary in your community to address [focus area X] ?

_________________________________________________________________________________

_________________________________________________________________________________

_____________________ __________________________________ _________

_________________ 16. What has facilitated your organizations working together with other organizations in your community on [ Auto
- filled by survey program] ?

_________________________________________________________________________________

_________________________________________________________________________________

____________________________________________________ _________

_________

___________ 17. What are the barriers to working together with other organizations in your community on [ Auto
- filled by survey program] ?

_________________________________________________________________________________

_________________________________________________________________________________

_____________________________________________ _________________

__________ 18. What recommendations would you have to improve interaction among organizations within your community in addressing [ Auto
- filled by survey program] ?

_________________________________________________________________________________

_______________________________________________ __________________________________

_________________________________________________________________________________ If an AmeriCorps grantee was identified in question 11 above, proceed with question 19:
19. You indicated that you have a relationship with [ Auto
- filled by survey program]. Are you aware that [ Auto
- filled by survey program] has AmeriCorps members serving with them?  Yes  No IF “YES” TO 19, ask 19a and 19b: 19a. Is your relationship a result, in whole or part, of the AmeriCorps members?

 Yes  No  So mewhat  Don’t know 19b. What role do AmeriCorps members have in the relationship?Partnership and Collaboration Survey 10/6/2014 Page 7

___________________________________________________________________________ __________

_________________________________________________________________ If 19=NO: 20. Are you aware that there are AmeriCorps members working in your community to address [focus area X]?  Yes  No If 19=YES or 20=Yes: 21. How effective are AmeriCorps members in your community in addressing [focus area X]?