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AMERICORPS MEMBER SURVEY QUESTIONS

Survey Instructions

The Corporation for National and Community Service (CNCS), with its contractor [TBD] is conducting a study of the 

School Turnaround AmeriCorps program, a partnership between CNCS and the Department of Education. The purpose of 

the study is to learn about how AmeriCorps programs are being implemented and how they are helping schools 

improve. 

You have been selected to complete a survey as part of the study. Your perspective is very important, so please answer 

honestly. Your participation in this study is completely voluntary. Refusing to participate will not involve any penalty or 

affect your [AmeriCorps status] [employment] in any way. It also will have no effect on your relationship with your 

school. It should take you approximately 30 minutes to complete the survey. Answer the questions based only on your 

experience [with your AmeriCorps program] [at your school] this year.

All responses are anonymous and your responses will be kept confidential to the extent provided by law. Under no 

circumstances will anyone from your [AmeriCorps program] [school] have access to any information that can be 

attributable to you. The information you provide in the survey will be summarized with the information from other 

respondents and included in a report that will be shared with your AmeriCorps program and with CNCS.

Please contact XXXX of XXXX, at XXX-XXX-XXXX or XXXX, if you have any questions regarding this research. 
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Note: If you serve at multiple schools, think about the school where you spend most of your time on questions that are specific to a 

school rather than the program overall.

 

1. In which school(s) did you serve?

___________________________________________________________________________________________________

a. If you served at multiple schools, where did you spend most of your time?___________________________________

2. If you served anywhere other than a school (ex. Afterschool program not on school grounds), where did you serve?

___________________________________________________________________________________________________

3. For how many weeks/months did you serve at your school(s)?______

_____ weeks OR _____ months

4. On average, how many hours per week did you serve at your school(s)?______

5. Did you provide direct services to individual students or to the whole classroom or school? (Check all that apply.)

__ AmeriCorps programming was targeted to individual students

__ AmeriCorps programming supported the whole classroom

__ AmeriCorps programming supported all students in the school

6. Did you work with special populations of students or students with specific needs? (Check all that apply.)

___ ELA (English Language Acquisition) / ELL (English Language Learner) / ESL ( English Second Language)

___ Low-performing in math

___ Low-performing in reading

___ At risk for dropping out

___ At risk for socio-emotional problems

___ Students with disabilities

___ Other: ___________________________________________________________________________________________

7. During the first semester, what did you do in your capacity as an AmeriCorps member? (Check all that apply.)

___ Tutored in math

___ Tutored in reading

___ Tutored in other subjects

___ Mentored students individually

___ Provided wraparound services

___ Provided extended learning time

___ Worked with afterschool program

___ Provided graduation coaching

___ Organized family/community events

___ Taught classes

___ Other: ___________________________________________________________________________________________

___ Not Applicable – I did not serve during the first semester

8. During the second semester, what did you do in your capacity as an AmeriCorps member? (Check all that apply.)

___ Tutored in math

___ Tutored in reading

___ Tutored in other subjects

___ Mentored students individually
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___ Provided wraparound services

___ Provided extended learning time

___ Worked with afterschool program

___ Provided graduation coaching

___ Organized family/community events

___ Taught classes

___ Other: ___________________________________________________________________________________________

___ Not Applicable – I did not serve during the second semester

9. What do you consider to be the most important school turnaround outcomes over the next two years for the students 

with whom you worked directly? (Check all that apply.)

___ Enhanced academic achievement

___Improved grades

___Improved completion of assignments

___Increased motivation

___Increased self-esteem

___ Improved attendance

___Improved socio-emotional health

___Improved behavior

___Other. If other, please specify __________________

10. Please fill in the following table about school turnaround outcomes for the students you worked with directly.

As a group, did the students you 

worked with directly show 

improvement in these area this 

year?

If you marked “Yes,” what were the outcomes 

with the greatest degree of improvement among 

the students you worked with?

Rank, with 1=Greatest improvement. Do not rank 

outcomes that you marked “No.”

Enhanced academic achievement, as 

measured by interim progress or unit 

assessments

___Yes ___No

Improved grades ___Yes ___No

Improved completion of assignments ___Yes ___No

Increased motivation ___Yes ___No

Increased self-esteem ___Yes ___No

Improved attendance ___Yes ___No

Improved socio-emotional health ___Yes ___No

Improved behavior ___Yes ___No

Other: __________________________ ___Yes ___No

11. Please indicate your level of agreement/disagreement with the following statements about your level of integration at 

the school.

Strongly 

Disagree Disagree Agree

Strongly 

Agree

Not 

Applicable

a. Teachers in this school share and discuss instructional 

practices with me.

b. Teachers in this school share and discuss behavioral 

management strategies with me.

c. Teachers in this school discuss their expectations for 

students with me.

d. Teachers and I collaborate successfully in supporting

students.
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e. I’m integrated into regular staff meetings and 

communication.

f. The principal and/or school leadership team 

communicates a clear vision of turnaround to me.

g. The principal and/or school leadership team monitors 

performance and progress of implementation of 

turnaround activities at this school.

12. For this school year, please indicate how satisfied you are with each of the elements listed below:

Very 

Dissatisfied Dissatisfied Satisfied

Very 

Satisfied

Not 

Applicable

a. Communication and collaboration between the 

teachers and myself

b. Communication and collaboration between the 

school leadership and myself

c. Training and support provided by grantee 

organizations.

d. Training and support provided by teachers in this 

school

e. My placement in meaningful service activities

f. Referral of students to me for services 

g. Matching me with students in need of academic 

strengthening and social/emotional supports

h. Sharing of outcome data by the school/district to 

review and assess student progress

i. My overall experience in supporting school 

turnaround in this school

j. This service experience in preparing me for my future 

education and/or career plans

13. In your opinion, how successful were your activities and contributions in the following areas this year? (Mark one 

response in each row.)

Very 

Unsuccessful

Somewhat 

Unsuccessful

Somewhat 

Successful

Very 

Successful

Not 

Applicable

a. Overall success of the AmeriCorps program

b. Improving the academic achievement of 

students I worked with directly, as measured by 

interim progress or unit assessments

c. Improving the socio-emotional health of 

students I worked with directly

d. Improving school climate

e. Improving the school’s capacity to implement its 

turnaround model

14. Prior to serving in AmeriCorps, to what extent were you interested in pursuing a career as a teacher?

[ ] Not interested [ ] Might be interested [ ] Interested [ ] Strongly interested

15. Prior to serving in AmeriCorps, to what extent were you interested in pursuing a career in another capacity related to 

education or youth development?

[ ] Not interested [ ] Might be interested [ ] Interested [ ] Strongly interested

Please explain_______________________________________________________________________
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16. At this point in time, to what extent are you interested in pursuing a career as a teacher?

[ ] Not interested [ ] Might be interested [ ] Interested [ ] Strongly interested

17. At this point in time, to what extent are you interested in pursuing a career in another capacity related to education or 

youth development?

[ ] Not interested [ ] Might be interested [ ] Interested [ ] Strongly interested

Please explain_______________________________________________________________________

18. Why did you join this AmeriCorps program? 

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________

19. What did you hope to accomplish this year? Did the experience meet your expectations? Why or why not?

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________

20. What worked particularly well this year at your school? Why do you think it worked well?

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________

21. What did not work well this year at your school? Why do you think that was the case? What suggestions do you have for 

improving the program for next year?

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________
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MEMBER EVALUATION OF IMPROVEMENT

Thinking about the student whose last name is closest to the beginning of the alphabet, and the student whose last name is 

closest to the end of the alphabet, please complete the following for those two students.

22. Since the beginning of the AmeriCorps program, to what extent has your student changed his or her behavior in terms of:

Student #1:

Significant 

Decline

Moderate 

Decline

No Change Moderate 

Improvement

Significant 

Improvement

Did not Need to 

Improve

a. Turning in his/her 

homework on time.

b. Completing homework 

to your satisfaction.

c. Participating in class.

d. Volunteering (e.g., for 

extra credit or more 

responsibilities).

e. Attending class 

regularly.

f. Being attentive in class.

g. Coming to school 

motivated to learn.

h. Getting along well with 

other students.

Student #2:

Significant 

Decline

Moderate 

Decline

No Change Moderate 

Improvement

Significant 

Improvement

Did not Need to 

Improve

a. Turning in his/her 

homework on time.

b. Completing homework 

to your satisfaction.

c. Participating in class.

d. Volunteering (e.g., for 

extra credit or more 

responsibilities).

e. Attending class 

regularly.

f. Being attentive in class.

g. Coming to school 

motivated to learn.

h. Getting along well with 

other students.