A r c h i v e d  I n f o r m a t i o n

Appendix A2
Program Profile

1. What is the maximum number of students /trainees your program can serve at one time? _________________

2. How many students /trainees are currently enrolled in your program? _________________

3. For Program Year _____ - _____ . specify the number of students /trainees served in your program in the following categories:

6. What is the average number of hours per week that students/trainees attend class or receive program services? ________ Hours

7. Approximately how many of your current students/trainees receive instructional services:

a.)	5 or more days/week?	______
	2 - 4 days /week?	______
	1 day or less/week?	______
b.)	During the day?	______
	In the evening?	______

8. To what extent are the needs of your students/trainees being met by services offered as part of your program? (For each row check the appropriate column.)

		Not at All	Somewhat	Fully	Don't Know
a.)	Child Care	______	______	______	______
b.)	Transportation	______	______	______	______
c.)	Health Services	______	______	______	______
d.)	Counseling	______	______	______	______
e.)	Job Search Assistance	______	______	______	______
f.)	Financial Assistance	______	______	______	______

9. To what extent do you rely on the following ways to recruit potential students/trainees? In responding, please assume that "very little" means that this approach accounts for less than 10% of your recruiting effort; that "some" means 10% to 50% of your recruiting effort; and "a great deal" means over 50% of your recruiting effort. (Check the appropriate column for each row in the following list.)

10. How many hours of volunteer time were donated to your program over the last program year? (if none, enter zero.)

Individual Tutoring: ______________hours

Classroom Instruction: ______________hours

Classroom/Instructional Aide: ______________hours

Support Services: ______________hours

Recruitment: ______________hours

11. Where would you place your program on the following continua: (Mark an 'X' on the appropriate line.)

	a.)	Highly Individualized Design	_____	_____	_____	_____	_____	Prestructured Fixed Design
	b.)	Emphasis on Academic Skills	_____	_____	_____	_____	_____	Emphasis on Workplace or Life Skills
	c.)	Student Designed or Selected Materials	_____	_____	_____	_____	_____	Program Designed or Selected Materials
	d.)	Reliance on Nationally Normed tests	_____	_____	_____	_____	_____	Reliance on Criterion Referenced Tests

12. How would you characterize the involvement of each of the following types of public and private organizations (other than your agency) with your program? For each row, check the appropriate column(s).

			Not significantly Involved	Involved in planning	Involved in recruiting/ referrals	Provide funding	Provided staff facilities, other resources.	Other (Specify below)
	a.)	Local school district	_________	_________	_________	_________	_________	_________
	b.)	Community college	_________	_________	_________	_________	_________	_________
	c.)	Area voc-tech schools	_________	_________	_________	_________	_________	_________
	d.)	State and local employment and training agencies	_________	_________	_________	_________	_________	_________
	e.)	Literacy councils/ organizations	_________	_________	_________	_________	_________	_________
	f.)	Religious groups	_________	_________	_________	_________	_________	_________
	g.)	businesses or labor unions	_________	_________	_________	_________	_________	_________
	h.)	Representatives of special adult populations	_________	_________	_________	_________	_________	_________
	i.)	Other fraternal voluntary or community organizations	_________	_________	_________	_________	_________	_________
	J.)	Public libraries	_________	_________	_________	_________	_________	_________
	k.)	Hospitals	_________	_________	_________	_________	_________	_________
	l.)	Other state and local agencies	_________	_________	_________	_________	_________	_________

13.	For your instructional program, what is the number of instructors and volunteers who are ... ?

a.)	Full-time paid instructors:	_____________
	Part-time paid instructors:	_____________
	Volunteer instructors:	_____________
b.)	Teach in the program:	Full-time Staff	Part-time Staff	Volunteers
	10 - 12 months/yr	_____________	_____________	_____________
	6 - 9 months/yr	_____________	_____________	_____________
	less than 6 months/yr	_____________	_____________	_____________
c.)	Teach:	Full-time Staff	Part-time Staff	Volunteers
	day classes only	_____________	_____________	_____________
	night classes only	_____________	_____________	_____________
	day and night	_____________	_____________	_____________
d.)	Have taught classes in your program:	Full-time Staff	Part-time Staff	Volunteers
	less than 1 year	_____________	_____________	_____________
	1 - 3 years	_____________	_____________	_____________
	over 3 years	_____________	_____________	_____________
e.)	Have completed:	Full-time Staff	Part-time Staff	Volunteers
	some college or postsecondary education	_____________	_____________	_____________
	BA/BS	_____________	_____________	_____________
	MA or higher degree	_____________	_____________	_____________
f.)	Are:	Full-time Staff	Part-time Staff	Volunteers
	certified specifically in adult education	_____________	_____________	_____________
	certified in area other than adult education	_____________	_____________	_____________
	not certified	_____________	_____________	_____________
g.)	Besides teaching:	Full-time Staff	Part-time Staff	Volunteers
	have no other program responsibilities	_____________	_____________	_____________
	have other program responsibilities	_____________	_____________	_____________

14. What percentage of your instructors have been provided with initial orientation or in-service training within the past program year? ________ %

15. During the past program year, which of the following forms of in-service training have been provided to your instructional staff? (Check all that apply.)

	a.)	No in-service training provided (Skip to 15)	________
	b.)	Assignment to work in the classroom of a more experienced teacher or staff member	________
	c.)	Participation in curriculum development	________
	d.)	Coaching by supervisors or others	________
	e.)	Workshops and conferences	________
	f.)	Participation in related university courses	________
	g.)	Other (specify)	________

16.	During the past program year, which of the following have been a major thrust of the in-service training for your instructors? (check all which apply.)

a.)	Improving reading instruction	________
b.)	Improving writing instruction	________
c.)	Improving math instruction	________
d.)	Improving vocational instruction	________
e.)	Assessing students/trainees needs	________
f.)	Recruiting students/trainees	________
g.)	Instructing students/trainees with physical handicaps and learning disabilities	________
h.)	Counseling and otherwise dealing with students'/trainees' personal problems	________
i.)	Providing instructors with occupational knowledge relevant to their students	________
j.)	Relating instruction to students'/trainees' ethnic/cultural backgrounds	________
k.)	Preventing student/trainee dropouts	________
l.)	Involving students /trainees in planning and evaluating their own programs of instruction	________

17.	What percentage of teachers use each of the following? (Check appropriate responses.)

		None	Few (less than 25%)	Some (25%-50%)	Most (over 50%)
a.)	Learning contracts	________	________	________	________
b.)	Student projects	________	________	________	________
c.)	Role play, learning games, simulations programs	________	________	________	________
d.)	Student participation in planning own program	________	________	________	________
e.)	Problem solving through discussion groups	________	________	________	________
f.)	Student participation in evaluating own learning gains	________	________	________	________
g.)	Student journals and/or exchange letters with students	________	________	________	________
h.)	Use of existing students in new student orientation	________	________	________	________
i.)	Student/teacher prepared instructional materials	________	________	________	________
j.)	Modes of assessment of learning gains other than tests (e.g. portfolios)	________	________	________	________

18.

To what extent does your program use each of the following learning environments? (In responding, assume that "very little" means less than 10% of total client instructional time; "some" means 10% to 50%, and "a great deal" means over 50% of total client instructional time. Check the appropriate column for each learning environment

		Not at All	Very Little	Some	A Great Deal
a.)	Individual instruction, (e.g., one-on-one tutoring)	________	________	________	________
b.)	Individual self-study with no instructor or tutor present	________	________	________	________
c.)	Small group instruction for students with similar problems	________	________	________	________
d.)	Classroom style instruction with 1 or more aides	________	________	________	________
e.)	Multi-media learning labs or centers	________	________	________	________
f.)	Computer-assisted instruction	________	________	________	________
g.)	Real or simulated workplace settings	________	________	________	________
h.)	Other (specify:_____________________)	________	________	________	________

19.

What is your program's total budget, not including non-cash contributions for the year ending June 30, 199__? $___________

20.	Over and above the budget amount you provided in response to Question 19. Do you receive any non-cash in-kind and/or donated contributions?

______Yes ______No

Roughly, how much of an increase would you need in your budget if you had to pay for the facilities, goods and services your program now receives as in-kind contributions?
_____None, no in-kind received
_____about a 25% increase
_____ about a 50% increase
_____ about a 75% increase
_____ about a 100% increase
_____ more than 100%
(if over 100%, what's your best guess?__________________ %)

a.)	Administrative Staff	_______%	$_______
b.)	Instructional Staff	_______%	$_______
c.)	Counseling Staff	_______%	$_______
d.)	Clerical and other staff	_______%	$_______
e.)	Instructional materials /equipment	_______%	$_______
f.)	Facilities	_______%	$_______
g.)	Utilities	_______%	$_______
h.)	Custodial Services	_______%	$_______
i.)	Office equipment/furniture/supplies	_______%	$_______
J.)	Other (specify):___________________	_______%	$_______
k.)	Other (specify):___________________	_______%	$_______
	TOTAL	100 %	$_______

* Should be equal to amount in Item 19

22.	Approximately what percentage of your total budget (see Item 19) comes from each of the following sources? (Answer using dollars or percentage, whichever is easier.)

a.)	Federal government (all sources)	_______%	$_______
b.)	State government (all sources)	_______%	$_______
c.)	Local government (all sources)	_______%	$_______
d.)	Private Sector Donations	_______%	$_______
e.)	Other	_______%	$_______
	TOTAL	100%	$_______

* Should be equal to amount in Item 19.

Appendix A1. Student Intake Form

Appendix A3. Student Instructional Status and Attendance Form