| Scroll
down to see directions on how to use this survey.
Please
note that the form on this page probably will not print out
well enough for you to use it with your beneficiaries. It
is only here to help you understand how to use the survey.
Click here to download a copy
that you can print out.
| 4-H
Service Project |
| Direct
Beneficiary Survey |
| |
| Project:
_____________________________________ |
| |
Today's
Date ______________
|
County
___________________
|
| Check
one: |
__ Male |
__ Female |
|
| Are
you a 4-H agent? |
___ Yes |
___ No
|
| A
4-H adult leader? |
___
Yes |
___
No
|
| A
community member? |
___ Yes |
___ No |
|
Please
read the following statements and check the box
which tells us your feelings as you participated
(or received service) with 4-H youth on this service
project. |
| As
I interacted with the 4-H youth, I thought
. . . |
Strongly
Disagree |
Disagree
|
Agree
|
Strongly
Agree |
1.
The youth seemed very engaged in working
on
the project |
|
|
|
|
| 2.
The youth were easy to talk to and listened
to me. |
|
|
|
|
3.
The youth were able to solve problems as
they
gave help to others. |
|
|
|
|
4.
My positive behavior served as a role model
to a
few youth. |
|
|
|
|
5.
I saw students showing concern for others
as they
participated in the project. |
|
|
|
|
6.
The youth were working on a project that
would
help my community. |
|
|
|
|
|
| |
| On
the following questions, please rate the effectiveness
of the project, where 1 = not effective, 2 = somewhat
effective, 3 = effective, 4 = very effective,
and 5 = highly effective. |
|
NE |
SE |
E |
VE |
HE |
| 7.
Does the project meet a need in your community? |
1 |
2 |
3 |
4 |
5 |
| 8.
Was this project useful for youth to do
as service? |
1 |
2 |
3 |
4 |
5 |
|
Please
put additional comments on the back.
THANK
YOU!
|
Directions
for Using the Direct Beneficiary Survey
This
survey is for people who directly received benefit from your
service learning project. Projects with direct beneficiaries
would include such things as tutoring, helping the elderly,
educational classes, or any project during which 4-H'ers have
one-on-one contact with those being served. Adults (agents
and volunteer leaders) working with the project should also
complete this survey.
This
survey should be given immediately after the service project
is completed. Please try to collect at least 10 surveys.
There
is a line near the top of the form labeled "Project."
Before giving out the surveys, fill in a name for your project,
such as "Senior Center computer classes" or "Clover
County Jr. Master Gardeners."
You
may add questions that you require for your own programming
needs. However, be sure not to alter the questions already
on the survey, as they will enable the 4-H service learning
evaluators to uniformly evaluate service efforts across Tennessee.
The
evaluation team will use the surveys in the impact study of
4-H service learning. Send your surveys to the state 4-H office,
so that they may be forwarded to the program evaluators.
4-H
Seeds of Service
2621 Morgan Circle, 205 Morgan Hall
Knoxville, TN 37996-4510
Before
sending the surveys, you can average together the responses
to #7 and #8 to answer the Service Learning Activity Report
Form question #9.
Direct
questions to Lori Jean Mantooth at Lmantoo1@utk.edu
or 865-974-2128.
For
projects giving indirect service to beneficiaries, please
use the Indirect Beneficiary
Survey. These beneficiaries would include such people
as visitors to parks, museums, libraries, or other public
places in which you do service. |
