Partnership and Collaboration Survey 10/6/2014 Page 1

Form Approved

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. The OMB control number for 

this project is_____. Public reporting burden for this collection of information is estimated to average __ minutes 

per response, including the time for reviewing instructions, searching existing data sources, gathering and 

maintaining the data needed, and completing and reviewing the collection 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 COLLABORATION 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 your 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. Your 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. It is 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 positive 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. 

Purposes 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 for the purpose of assisting the 
Partnership 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 assistance. 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 to 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 how 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/maintenance)

 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 know
Partnership and Collaboration Survey 10/6/2014 Page 4

10. Which of the following coalitions, workgroups or committees are you currently actively 

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. 

Organization 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.

- Management

means working 

together to develop 

or implement 

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 direct 

services, such as 

coordinating 

activities, giving or 

receiving referrals

Org. A  Less than 1 year

 1 to 5 years

 6 to 10 years

 10 to 20 years

 20+ years

 Don’t know

 Resources

 Management

 Organizational 

 Service 

provision

 Other

 Don’t Know

 Not strong

 Neither strong nor

weak

 Somewhat strong

 Very strong

 Don’t know

 Not valuable

 Neither valuable

nor not valuable

 Somewhat

valuable

 Very valuable

 Don’t know

 Yes

 No

 Don’t know

Org. B

Org. C

13. Select up to the 7 organizations with whom you communicate with most frequently.

 Organization A

 Organization 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 

Know
Partnership 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

 Somewhat

 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]?