Draft 1/21/15 1 **AmeriCorps Bundling Survey** Thank you for your willingness to complete this survey
. Your respo nses to this survey will be kept confidential and your responses will only be reported summarized with other responses. This is NOT a test. There are no right or wrong answers to the questions, so please choose the responses that best apply to you
. This survey will take approximately 20 minutes to complete. This study will take place over the course of two years. In order to track your responses confidentiall y over time, we are asking that you create a code that will enable us to link your surveys to each other. First three letters of the city or town in which you were born: _ _ _ [For example: S P R for Springfield] Number of letters in your last name: _

_ [For example 0 5 for Smith] First 2 lette rs of your mother’s first name: _ _ [For example M A for Mary. If unknown, enter “AA”):] 1. Date of birth [Month/day/year] 2. Gender o Male o Female o Other (specify): ____ 3a. Are you a parent or primary caregiver of a child? o No o Yes, and all of my children live with me o Yes, and some of my children live with me o Yes, and none of my children live with me 3b. Are you a primary caregiver of a parent or other adult? [No, Yes] 4. Have you served on active duty in the military? [No, Yes] 5a. What is your race?  American Indian or Alaska Native  Asian  Black or African American  Native Hawaiian or Other Pacific Islander  White  Other (specify) 5b. What is your ethnicity? o Hispani c or Latino o Not Hispanic or Latino 6 . Where do you currently live? a. City or town _______ b. Zip code ______Draft 1/21/15 2

7 . Check the highest level of education that you have completed:  Middle school  Some high school  High school diploma or GED  Technical school / Apprenticeship  Some college  Associate’s degree  Bachelor’s degree  Graduate degree  Other (please specify): __________ [If applicable] When did you receive a high school diploma or GED? What month and year? 8 . When were you last enroll ed in school
– What was the month and year? 9 . What school did you most recently attend ?  Middle school  High school  Vocational/technical/alternative school  Community college  4
-year college 10 . Are you currently employed? [No; Yes] 1 0a. [If Yes] Please describe your current employment status:

 Part
-time 1
-20 hours per week  Part time 21
-39 hours per week  Full
-time 40 or more hours per week 1 0 b. [If Yes] How long have you held your current position?  Less than 1 month  1 to 3 months  4 to 6 months  More than 6 months
1 0c. [If No] Please describe your current employment status:  Looking for work  Not looking for work  Disabled, not able to work  Pursuing school or training instead of work  Engaged in part
-time volunteer position, internship, or apprenticeship  Engaged in full
-time volunteer position, internship, or apprenticeship 1 0 d. [If No] Please assess if the follow factors are barriers to employment for you personally [Large barrier to employment, a barrier but can be overcome, not a barrier to employment]: a. No jobs available where I liveDraft 1/21/15 3 b. Do not have enough work experience for the job I want c. Do not have enough education for the job I want d. Have family or other responsibilities which inte rfere e. Do not have transportation f. Not good at interviews or do not know how to create a resume g. Can make more money not in an “official” job h. Criminal record makes it difficult to find a job i. Credit issues make it hard to find a job j. Illness or injury makes it challenging to find a job k. Do not wish to work 1 1 . How much money did YOU personally earn in [201x]?

__________ 1 2 . Have you ever done any of the following?  A paid part
-time job  A paid full
-time job  A paid internship  An unpaid internship  Volunteer work that was not part of a requirement for high school graduation  Received a stipend for attending a program ( note: does not include AmeriCorps )  Baby
-sitting, yard
-work or chores that you were paid for by a friend or neighbor 1 3
. How much do you agree or dis agree that each of the following statements describes you? [Strongly Agree; Agree; Neither Agree nor Disagree; Disagree; Strongly Disagree]. a. I can always manage to solve difficult problems if I try hard enough b. If someone opposes me, I can find the means and ways to get what I want c. It is easy for me to stick to my aims and accomplish my goals d. I am confident that I could deal efficiently with unexpected events e. Thanks to my resourcefulness, I know how to handle unforeseen situations f. I can solve most problems if I invest the necessary effort g. I can remain calm when facing difficulties because I can rely on my coping abilities h. When I am confronted with a problem, I can usu ally find several solutions i. If I am in trouble, I can usually think of a solution j. I can usu ally handle whatever comes my way 14
. If you found out about a problem in your community that you wanted to do something about, how well do you think you would be able to do each of the following : [I definitely could do this; I probably could do this; Not sure; I could not do this; I definitely could not do this] a. Create a plan to address the problem b. Get other people to care about the problem c. Organize and run a meeting d. Express your views in front of a group of people e. Identify individuals or groups who could help you with the problem f. Express your views on the I nternet or through social media g. Call someone on the phone you had never met before to get their help with the problem h. Contact an elected official about the problemDraft 1/21/15 4

1 5
. How much confidence do you have that you could: [ No confidence at all; Very little confidence; moderate confidence; Much confidence; Complete confidence]
a. Use the internet to find information about occupations that interest you. b. Select one occupation from a list of potential occupations you are considering. c. Determine what your ideal job would be. d. Prepare a good resume. e. Decide what you value most in an occupation. f. Find out about the average yearly earnings of people in an occupation. g. Identify employers, firms, and institutions relevant to your career possibilities. h. Successfully manage the job interview process. i. Identify some reasonable career alternatives if you are unable to get your first choice. j. Determine the steps to take if you are having academic trouble
. k. Complete a college or trade school application. l. Apply for financial aid to further your educational goals. m. Obtain formal training needed to support your career goals. n. Pass a college course, o. Obtain technical or vocational certification. p. Sign up for he alth care q. Obtain housing vouchers or other housing assistance r. Find community resources that address your needs 16
. How much do you agree or disagree with the following: [Strongly Agree; Agree; Neither Agree nor Disagree; Disagree; Strongly Disagree]. a. I have a strong and personal attachment to a particular community b. I am aware of the important needs in the community c. I feel a personal obligation to contribute in some way to the community d. I am or plan to become actively involved in issues that positively a ffect the community e. I believe that voting in elections is a very important obligation that a citizen owes to the country 17
. Generally speaking, would you say that you can trust all the people, most of the people, some of the people, or none of the people in your neighborhood? a. All of the people, b. Most of the people c. Some of the people d. None of the people 18
. Please indicate how much you agree or disagree with the following statements. [Strongly Agree; Agree; Neither Agree nor Disagree; Disagree; Strongly Disagree].
a. I have a clear idea of what my career goals are b. I have a plan for my career c. I intend to pursue education beyond high school (e.g. college, trade school) d. I know what to seek and what to avoid in developing my career pathDraft 1/21/15 5

19
. In the last 6 months, have you done any of the following?
a. Sent in a resume or completed a job application b. Written or revised your resume c. Interviewed for a job d. Contacted a potential employer e. Talked with a person employed a field you are interested in f. Taken a GED test g. Completed a course in high school, college, or an alternative school h. Completed a college o r trade school application i. Completed a FAFSA application j. Enrolled in a college, trade school, or a certification course 20
. In the last 6 months, have you looked for any of the following? a. Full
-time work b. Part
-time work c. Internship or apprenticeship d. Volunteer position 21
. Are you currently using or visiting any of the following? a. Local employment development division b. Housing center c. Job center d. Domestic violence center e. Food bank f. Community health clinic g. Adult school / community college extension programs h. Mutual support or other assistance programs (e.g. AA, NA, AlAnon, grief support groups ) 22 . Are you currently accessing any of the following federal or state government supports? a. Food assistance (e.g. WIC, SNAP) b. Health care assistance (e.g. Medicaid) c. Housing assistance (e.g. housing vouchers) d. Other financial or practical assistance (e.g. TANF, child care assistance programs) 23 . Have you ever been convicted as an adult, or adjudicated as a juvenile offender, of any offense by either a civilian or military court, other than minor traffic violations? [No, Yes] 24 . Are you currently facing charges for any offense or on probation or parole? [No, Yes] 25 . Are you limited in any way in any activities because of p hysical, mental, or emotional problems? [No, Yes] 26. Were you registered to vote in the last presidential election ? a. Yes b. No c. No I was not eligible to vote d. Don’t k nowDraft 1/21/15 6

27. Did you vote in the last presidential election? a. Yes b. No c. No I was not eligible to vote d. Don’t k now 28. In the last 12 months, how often did you participate in the following activities? [Basically every day, a few times a week, a few times a month, once a month, less than once a month, not at all] a. Participate in com munity organizations (school, religious, issue

- based, recreational) b. Keep informed about news and public issues c. Help to keep the community safe and clean d. Volunteer for a cause or issue that I care about e. Donate money or goods to a cause or issue that I care about 29
. What programs are you participating in or services are you receiving? a. AmeriCorps or similar national or community service program b. Employment supports ( e.g. job training) c. Educational supports (e.g. tutoring, GED classes, college enrollment assistance)