Montana Campus Corps:
College Students Meeting Critical Community Needs

COMMUNITY PARTNER SURVEY (CAMPUS CORPS)

For Campus Corps supervisors at partnering agencies, clinics and schools. (Please direct any questions to info@mtcompact.org)
Name of community-based agency, clinic or school:   *
City:   *   State:   *
Local campus affiliation:    *
 
Person submitting this form:
First Name:   * Last Name:   * Title:  
E-mail:   *
Click here if you're completing this on behalf of someone else.

Indicate the number of Campus Corps members hosted by your agency in 2011-2012   *
Date member(s) completed service at your agency:  (mm/dd/yyyy) *
May we add you to our list of Campus Corps stakeholders and keep you up-to-date on news and events?
NOTE: Contact information will be kept confidential and will not be posted in a public venue.
Yes   No  *

AGENCY INFORMATION

1. Indicate which of these focus areas most closely align(s) with the work of your school or agency and its programs:
NOTE: you may include more than one, where appropriate.
 Education
 Healthy Futures
 Disaster Services
 Veterans & Military Families
 Economic Opportunity
 Environmental Stewardship
 Other 
(If you chose other, please specify)  *

2. Which of these best describes your school or agency's location?  
Urban   Rural   Tribal *


3. Briefly describe the clients/beneficiaries of your school or agency and its programs:
 *

4. Please list three specific examples of direct services provided by the Campus Corps member(s) at your school or agency this year.
 *

MEMBER IMPACT

5. Which of these best describes the expertise (i.e., level of preparedness) of your Campus Corps member(s) to meet community needs at the beginning of the service term?
Very prepared   Adequately prepared   Somewhat prepared   Not at all prepared  *

Additional comments:

6. Which of these best describes the expertise (i.e., knowledge or skills) of your Campus Corps member(s) to meet community needs at the end of service?
Very prepared   Adequately prepared   Somewhat prepared   Not at all prepared  *

Additional comments:

7. To what degree did the service of the Campus Corps member(s) increase your organization's resources?:
NOTE: these can be financial, human or other tangible resources.

Very Significant  Significant degree  Moderate degree  Not at all *

Additional Comments: Please specify ways in which your organization's resources have increased due to the service of the Campus Corps member(s)

8. To what degree did the service of the Campus Corps member(s) increase your organization's capacity to meet community needs? Example: development of programs, recruitment/management of volunteers, implementation of new systems, etc.
Very Significant  Significant degree  Moderate degree  Not at all *

Additional Comments: Please specify ways in which your organization's capacity has been increased due to the service of the Campus Corps member(s)

9. Do you require additional training or technical assistance with regard to the Campus Corps AmeriCorps program?
Yes  No *

If Yes, please list specific training needs:

GREAT STORIES

Please share a brief narrative or "great story," which exemplifies the impact of Campus Corps members' service at your school or agency

NOTE: Stories may be used in press, marketing materials, or funder reports. Please only share what you feel comfortable having in print.

Would you like someone from the MTCC Network Office to contact you regarding your survey responses?:
Yes  No *


* Indicates Required Field