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| PLEASE RETURN SURVEY BY___________________________________________ We welcome your feedback on how well (the initiative) is doing. For each item, please circle the number that best shows your satisfaction with that aspect of the initiative. Provide additional comments if you wish. |
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PLANNING AND IMPLEMENTATION: |
very dissatisfied |
very satisfied | ||||
| 1. | Planning process used to prepare the objectives for the initiative | 1 | 2 | 3 | 4 | 5 |
| 2. | Follow-through on the initiatives activities | 1 | 2 | 3 | 4 | 5 |
| 3. | Strength and competence of staff | 1 |
2 | 3 | 4 | 5 |
| comments: | ||||||
| LEADERSHIP: | ||||||
| 4. | Clarity of the vision for where the initiative should be going | 1 |
2 | 3 | 4 | 5 |
| 5. | Strength and competence of leadership | 1 |
2 | 3 | 4 | 5 |
| 6. | Sensitivity to cultural issues | 1 |
2 | 3 | 4 | 5 |
| 7. | Use of the media to promote awareness of the initiatives goals and accomplishments | 1 |
2 | 3 | 4 | 5 |
| comments: | ||||||
| SERVICES: | ||||||
| 8. | Opportunities for members of the initiative to take leadership roles | 1 |
2 | 3 | 4 | 5 |
| 9. | Training and technical assistance | 1 |
2 | 3 | 4 | 5 |
| 10. | Fund-raising and grant-writing | 1 |
2 | 3 | 4 | 5 |
| 11. | Information and referral | 1 |
2 | 3 | 4 | 5 |
| 12. | Advocacy | 1 |
2 | 3 | 4 | 5 |
| comments: | ||||||
| COMMUNITY INVOLVEMENT IN THE COALITION: | ||||||
| 13. | Participation of influential people from key sectors of the community | 1 |
2 | 3 | 4 | 5 |
| 14. | Participation of people of color | 1 |
2 | 3 | 4 | 5 |
| 15. | Diversity of membership of the initiative | 1 |
2 | 3 | 4 | 5 |
| comments: | ||||||
| PROGRESS AND OUTCOME: | ||||||
| 16. | Progress in meeting the initiatives objectives | 1 |
2 | 3 | 4 | 5 |
| 17. | Success in generating resources for the initiative | 1 |
2 | 3 | 4 | 5 |
| 18. | Fairness with which funds and opportunities are distributed | 1 |
2 | 3 | 4 | 5 |
| 19. | The initiatives contribution to (list major goal) | 1 |
2 | 3 | 4 | 5 |
| 20. | The initiative's contribution to (list other major goals, if appropriate) | 1 |
2 | 3 | 4 | 5 |
| comments: | ||||||
| OVERALL APPROVAL RATING: | ||||||
| 21. | Is the community better off today because of (the initiative)? | 1 |
2 | 3 | 4 | 5 |
Yes |
No | |||||
OVERALL COMMENTS: ______________________________________________________________________________________________ ______________________________________________________________________________________________ |
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[References]