Sample Survey of Stakeholders

SAMPLE DOCUMENT

 

Thank you for agreeing to complete this short survey on the inclusiveness practices of ______________________ (name of organization). We seek to become more inclusive of communities of color. Your participation in this survey will influence our efforts. Your  responses will be confidential. When you have finished the survey, please return it to: (list contact person, name of organization, and address).

 

 

Your position with ____________________ (name the organization).

Check the term that best describes your primary role with the organization.:

____ Staff

____ Board

____ Donor 

____ Former Board Member 

____ Former Staff Member 

____ Volunteer

____ Client 

____ Community Partner (working closely with the organization)

____ Community Leader

____ Community Member

 

 

Your Race/Ethnicity

____ African American 

____ Asian/Pacific Islander 

____ Latino/Chicano/Hispanic 

____ Middle Eastern

____ Mixed Racial/Ethnic Background 

____ South Asian

____ Other ______________

____ White/Caucasian 

 

 

 

Please answer the questions below using the following scale and/or with a written answer: 

1 = not at all   2 = a little bit    3 = somewhat    4 = quite a lot   5 = a great deal   dk = don't know

For the purposes of this survey, inclusiveness is defined as...

 

 

 

 

Organizational Mission

The mission of _____________________________ (name of organization) is... (Fill this in ahead of time so that respondents can reflect on the actual mission.)

 

(1) Does the mission of _____________________________ impact communities of color? 1 2 3 4 5 dk

(2) Do you feel that communities of color generally respond positively to ________________________'s mission? 1 2 3 4 5 dk

(3) Are the values related to inclusiveness that are espoused by _____________________________ consistent with the values that it practices?  1 2 3 4 5 dk

(4) Do you have any suggestions about how _____________________________'s mission statement could be changed to expand inclusiveness?  

(5) Please provide further comments related to mission-related issues here: 

 

 

 

 

Board of Directors 

(1) Do you feel people of color generally feel comfortable serving as members of the board of directors of _____________________________?  1 2 3 4 5 dk

(2) Do people of color and white people generally serve as directors for the same amount of time? 1 2 3 4 5 dk

(3) Does the board of directors of ______________________________ consider issues relating to race and ethnicity when it sets policies and makes decisions for the organization?  1 2 3 4 5 dk

(4) What could the board of directors of _____________________________ do differently to become more inclusive, if anything?

(5) What could the board of directors of _____________________________ do differently to address the needs of communities of color, if anything? 

(6) Please provide further explanation on any governance-related issues here: 

 

 

 

 

Personnel

(1) Are people of color and white people with similar professional backgrounds and skills recruited and promoted equally at _____________________________?  1 2 3 4 5 dk

(2) Has _____________________________been able to effectively retain people of color?  1 2 3 4 5 dk

(3) Are staff at certain levels of the organization more likely to be people of color than at other levels? 1 2 3 4 5 dk

(4) What factors have influenced retention among people of color at _____________________________?

(5) What could _____________________________ do, if anything, to recruit and retain staff members of color at all levels? 

(6) Please provide further explanation on any personnel-related issues here:

 

Programs

(1) Does _____________________________specifically consider race/ethnicity and/or culture in designing and implementing programs? 1 2 3 4 5 dk

(2) Does _____________________________make services available in geographic locations that are convenient and accessible to communities of color? 1 2 3 4 5 dk

(3) Does _____________________________translate materials into languages that are spoken by communities of color in its service area? 1 2 3 4 5 dk

(4) Is there anything that _____________________________does to hinder providing services to people of color?  Please explain.

(5) Please provide further explanation of any program-related issues here:

 

This worksheet was created by The Denver Foundation's Inclusiveness Project (http://www.nonprofitinclusiveness.org/) to support organizations doing inclusiveness work.

Users are encouraged to customize the worksheet (both content and formatting) to meet the needs of their respective organizations.

A Word version is attached. A writable PDF version is also attached.

 

 

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