I. Organization/School Information

Name of Organization/School:

Name of Organizer (main contact):

Title:

City:      State:    

Phone:

Email (required):

County (required): Please select... Addison Bennington Caledonia Chittenden Essex Franklin Grand Isle Lamoille Orange Orleans Rutland Washington Windham Windsor

II. Volunteer Information

Number of volunteers involved in all GYSD projects: Please select... 0 to 10 10 to 20 20 to 30 30 to 40 40 to 50 50 or more

Number of volunteers who were youth (ages 5-25): Please select... 0 to 10 10 to 20 20 to 30 30 to 40 40 to 50 50 or more

Of these youth, what percentage were (total should be 100%):

Under 15:      15 and over:

How many hours did the average volunteer serve?
(include time involved in project planning, project completion, and project evaluation/reflection/follow-up):

To the extent you have access to this information, did youth not normally asked to serve participate in GYSD ?
If yes, please indicate number:

Younger youth (ages 5-14):
Youth with disabilities:
Youth in the juvenile justice system:
Youth in foster care:
Youth in difficult circumstances (please describe, eg. refugees):

Estimated number of volunteers by gender:

Female:     Male:

Estimated number of volunteers by ethnicity:

African American:
Caucasian:
Latino:
Native American:
Asian:
Other:

III. Information about Service Projects

What issue did your project address?  Please select... Poverty, Hunger, Homelessness Education and Youth Development Civil Rights—Equality and Empowerment Physical and Emotional Health Environment and Climate Change Sustainable Community Development Public Safety, Crime & Violence Disaster Prevention & Relief Global Citizenship & Cooperation Immigrant/Refugee Assistance Veterans and Military Senior Citizens Civic Engagement

Please describe the goals of your service project(s). What did you want to accomplish?

How do you know that you were successful in accomplishing your goals? Please explain.

Please describe how youth were involved in planning for and implementing Global Youth Service Day projects (e.g., researching community needs, selecting/designing project, contacting media, budget preparation, evaluation, etc.).

Did you put on a celebration event? Please select... Yes No

Did you make any community partner connections?  If so, please list.

IV. Impact of Global Youth Service Day

Please describe quantitative results of projects implemented by your coalition:

Estimated number of people served:
Estimated number of items or services delivered (eg. trees planted, houses built, trainings offered):

Please describe qualitative results of projects implemented by your coalition:

Project-specific community changes (eg. neighbors educated about use of low energy light bulbs)

Changes in the behavior of people that participated in GYSD (e.g. youth pledged to have healthy snacks)

Influenced public policy (example: can be rules in schools, local ordinance, or legislation)

Benefits to youth volunteers:

Please describe academic skills and/or knowledge that youth volunteers acquired through participation in the service project. If possible, please list by academic topic (science, history, etc.)

Please describe applied skills and/or knowledge (non-academic) that youth volunteers acquired through participation in the service project: Please be specific.  Examples include: job readiness skills (eg. interpersonal communications, professional ethics, teamwork), personal or life skills (e.g. onfidence, self-esteem, responsibility, empathy), and awareness about community and issues.

V. Media

What media attention did your Global Youth Service Day projects receive? 

Please list the reporter(s) that covered your project.  Please include name, name of publication/station, address, phone, and e-mail address, if possible.

Did you follow up with any media and sponsors?  Please select... Yes No

VI. Elected Officials and Public Figures

How were government officials and/or other public figures involved with your GYSD events?  Please describe who was involved (include names and titles) and how they participated (For example: Governor Owens issued a proclamation, US Senator Allard spoke at opening ceremony, the Portland Trailblazers hosted a leadership camp for the youth planning team, etc).

Did you follow up with any public officials?  Please select... Yes No

VII. General Questions

Is this something you would like to do again?  Please select... Yes No

What would you like to see next year from us as a lead agency?