Sample Coalition Survey

As part of the Strengthening Community Programs for Children, Youth and Families at Risk grant, the staff from the University of Missouri-Kansas City Institute for Human Development is conducting a survey of individuals who have participated in activities with (Dent County or Jackson County) activities. The purpose of this survey is to identify community participation on the survey and to assess the impact of the program's activities on the community. We would appreciate your answering the following questions about the Missouri Youth Initiative grant activities.

1. In what context have you worked with the Strengthening community Programs for Children, Youth and Families at Risk in (Dent County/East Meyer Office)?

  1. (  ) Worked with their Coalition
  2. (  ) Helped develop some of the programming
  3. (  ) Networked with other community agencies in behalf of the program
  4. (  ) Helped raise funds or find other monies to support activities
  5. (  ) Helped with implementing the activities
  6. (  ) Other, specify:________________________________________

2. To what extent is your contact with other members due to your participation on this project. (Check one)

  1. (  ) Not at all - we almost certainly would have interacted to the same extent without the Coalition
  2. (  ) Slightly - we would probably still have interacted but to a slightly less extent
  3. (  ) Moderately - we would probably still have interacted but to a much lesser extent
  4. (  ) Very much - we probably would not have interacted and if so it would have been to a much lesser extent
  5. (  ) We almost certainly would not have interacted at all without the Coalition

3. How frequently did you usually interact with most of these other members?

  1. (  ) a few times a year
  2. (  ) about once a month
  3. (  ) about once a week
  4. (  ) more than once a week
  5. (  ) almost every day

4. How likely is that you would continue working with these other members if the (Dent County/East Meyer) no longer existed? (Check one)

  1. (  ) very unlikely
  2. (  ) unlikely
  3. (  ) as likely as not
  4. (  ) likely
  5. (  ) very likely

5. To what extent were your interactions with these other members worthwhile and productive? (Check one)

  1. (  ) not at all
  2. (  ) slightly
  3. (  ) moderately
  4. (  ) quite a bit
  5. (  ) very much

6. To what extent has your interaction with these other members improved your ability to achieve your own goals? (Check one)

  1. (  ) not at all
  2. (  ) slightly
  3. (  ) moderately
  4. (  ) quite a bit
  5. (  ) very much

7. How well are the activities of your organization and those of these other members' organizations coordinated? (Check one)

  1. (  ) not applicable - activities not coordinated or no activities to coordinate
  2. (  ) very poorly
  3. (  ) poorly
  4. (  ) adequately
  5. (  ) well
  6. (  ) very well

 

Coalition effects

For each of the items below, please rate the extent to which the activities under "Strengthening Community Programs for Children, Youth and Families at Risk" grant has impacted your organization and the community. Please tell us which is your choice: Very little; Little; Some; Great; Very great.

  Very little Little Some Great Very Great
The extent to which the Coalition has:
1.  Led to increased cooperation among organizations in the Coalition. 1 2 3 4 5
2.  Led to greater networking and exchange of information. 1 2 3 4 5
3.  Taken active steps to include members who are representatives of the community in their activities. 1 2 3 4 5
4.  Sufficient citizen or community involvement. 1 2 3 4 5
5.  Led to greater cooperation and networking among agencies in the community. 1 2 3 4 5
6.  Enabled you to become more aware of what other organizations do. 1 2 3 4 5
7.  Enabled you to form personal contacts with other organizations. 1 2 3 4 5

8.  How many hours have you participated in activities (of Dent County/East Meyer) over the past year?

  1. (  ) Never participated in any of these activities
  2. (  ) Less than one hour
  3. (  ) 1-2 hours
  4. (  ) 3-5 hours
  5. (  ) 6-10 hours
  6. (  ) 11 or more hours

How would you rate the impact or effect of the (Dent County/Eat Meyer) program on the community? Please answer to each item below if you "disagree to a great extent," "disagree," are "unsure," "agree," or "agree to a great extent."

  Disagree to a great extent Disagree Unsure Agree Agree to a great extent
9.  Dent County/East Meyer has added needed programs to the neighborhood 1 2 3 4 5
10.  Dent County/East Meyer is a place for residents to go for services 1 2 3 4 5
11.  Dent County/East Meyer adds resources to the community 1 2 3 4 5
12.  This project has had a big impact on the neighborhood. 1 2 3 4 5

 

13.  What challenges do you see that the program faces?

 

14.  If you were making changes to enhance the program in this area, what would they be?

 

What is your discipline?
  • Social worker
  • Nurse
  • Educator
  • Other (specify)_________________________________
  • ZIP code where you work:

    Type of agency:

    • Clinic setting
    • Health department for mothers (e.g., Teen MOMs)
    • Early intervention program (e.g. Head Start)
    • Other (specify)_________________________________

    Number of Coalition meetings attended over the last year:

    Number of committee meetings attended over the last year: