AmeriCorps survey
Name
First Name
Last Name
Email
example@example.com
I am a
Community Volunteer
College Volunteer
Grow Appalachia Participant
Year-round AmeriCorps member
Six month AmeriCorps member
Summer AmeriCorps member
This is a
Pre-test
Post-test
Because you are, or have been, a High Rocks participant, you are invited to participate in the following survey. Information from this survey will help High Rocks improve its services and learn more about how it is affecting participants. This survey will take approximately 10 minutes to complete and your participation is voluntary. All survey responses will be combined and reported in summary form and respondents will remain anonymous in any evaluation report we write. You have the option to give High Rocks staff access to your survey answers so they can learn more about you and support you as best as possible.You may choose not to answer some of the questions in this survey, or you may choose not to participate at all, without any negative consequences. There are no right or wrong answers.If you have questions or concerns about the survey, please contact Renae Hall at renae@highrocks.org. We look forward to your participation! -By selecting the first ‘yes’ you acknowledge that you have read and understood the statement above, that you agree to participate in this survey, and that you agree to give High Rocks staff access to your answers. Select the second ‘yes’ to indicate that you have read and understood the statement above, that you agree to participate in this survey, but that you do NOT agree to give High Rocks staff access to your answers. Select ‘no’ if you do not wish to participate in this survey at all.
Yes, I agree to participate in this survey, and I agree to give High Rocks staff access to my survey answers
Yes, I agree to participate in this survey, but do NOT agree to give High Rocks staff access to my survey answers
No, I do not want to participate in this survey
Back
Next
Using the following scale, please rate the degree to which each statement below is like you
1- Not like me at all
2- A little like me
3- Usually like me
4- A lot like me
DK- Don't know
1. I am willing to speak up for my ideas
2. I create an atmosphere of acceptance
3. I have values of my own and can stand up for them
4. I can set realistic goals
5. I can consider alternative ways of doing things
6. I can say something difficult to someone in a productive way
7. I can stay calm in stressful situations
8. I can listen effectively
9. I seek out new experiences
10. I am adaptable and flexible in my thinking and ideas
11. I am confident I can succeed when I apply myself
12. I consider the needs of others
13. I consider input from all group members
14. I can handles mistakes
15. I try things even if I might fail
16. I am motivated to learn
17. I complete my to-do list regularly
18. When I make a mistake, I try to figure out what went wrong
19. I think of my mistakes as valuable opportunities to learn
20. I see the world's problems as opportunities for me to participate and contribute
21. I like to the role I am filling and my responsibilities
22. I revise my plans as I learn, change and grow
23. I like learning interesting things
24. It's important to me that I improve my skills this year
25. As things stand now, how far in school do you intend to go? Please select the answer that best describes your plans.
Less than high school graduation
High school graduation or GED only
Attend or complete a 2-year school course in a community or vocational school
Attend a college, but not complete a 4-year degree
Graduate from college
Obtain a Master's degree or equivalent
Obtain a Ph.D., M.D., or other advance degree
Don't know
26. did you plan to continue your education right after high school or take a non-traditional route? Please select the answer that best describes your plans.
Yes, I attended college right after high school
Yes, I attended college after staying out of school for a year
Yes, I attended college after staying out of school for over an year
I intend to attend college but I don't know when
No, I don't plan to continue my education after high school
I don't know if I will continue my education after high school
Back
Next
Use the following scale, please rate the degree to which each statement below is like you.
1- Not like me at all
2. A little like me
3. Usually like me
4. A lot like me
DK- Don't know
27. I can love my body the way it is
28. When it is appropriate, I can speak directly and honestly with others about who I am, what I feel, and what I want
29. I communicate my anger or upsets without blaming others
30. I have enough energy
31. My emotional health is good and I can manage it.
32. I eat healthy food.
33. I develop and maintain healthy relationships with others.
34. I feel proud that I have accomplished things in my life.
35. My body is strong and can do lots of things.
36. I do not abuse drugs or alcohol.
37. I help grow, cook or share healthy food.
38. I have the ability to make friends and create valuable relationships in a new place.
39. I am friends with myself.
40. My life has meaning.
41. I have the ability to make a difference in my community.
42. I can identify community needs.
43. I care about my community.
44. I believe my community is important.
45. Someone from my community has mentored me.
46. I believe that it is important to be informed of community issues.
47. I often discuss and think about how larger political and social issues affect my community.
48. I have made new friends as a result of participation in a community group.
49. I am involved in structured volunteer position(s) in the community.
50. I participate in discussions about social issues.
51. I believe we can do more working together as a team to help our community than we can do alone.
Submit
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