After-School Initiative's Toolkit for Evaluating

Appendix VI. Protocol Worksheet for ASI Toolkit Survey Administration
Instructions: Complete a separate protocol worksheet for each activity or group of surveys administered and submit to
your evaluation liaison no later than two weeks before the survey administration date. Some grantees may only fill out one
worksheet for all program activities offered.
Background Information:
a) Grantee name:_______________________ b) Contact name:_______________________
c) Contact phone:______________________ d) Contact e-mail:______________________
e) Activity name:_____________________________________________________
Question
1) Which youth participants are eligible
to take the survey?
Eligible youth should include all registered
participants in 4th –9th grade unless a sampling
plan is developed or you and your evaluation liaison
agree on another standard. Consult with your
evaluation liaison.
2) How many youth will you ask to take
the survey?
This should equal the number of eligible
participants minus the number of youth for which
you do NOT have consent forms.
Response
3) Will the survey be administered in
Spanish as well as English? Yes No
4) When will data be collected?
More than one date may need to be scheduled if it
will help improve the response rate. Consider
attendance on each day of the week and whether the
same youth attend on multiple days.
Provide an adequate amount of time for completion
so that youth do not feel rushed or like they are
missing out on other program activities.
1st Date:
Time: From ________ to ________
2nd Date:
Time: From ________ to ________
3rd Date:
Time: From ________ to ________
5) Who will serve as the survey
administrator?
6) Who will serve as the Spanishspeaking
survey administrator?
If needed.
Name: _______________________________
Name: _______________________________
Toolkit for Evaluating Positive Youth Development 56