Program Characteristics Survey

Program Name
Contact Person
Address
        
           Number                               Street

        
           City
         State      Zip -
Email

I   Audience
(Please fill in the estimated percentages of people in each of the following categories)

Participant Information

If you have no idea about these percentages check Don't Know, if you are not very
sure of these numbers then check Rough Estimate or if you are sure check Fairly Accurate
Don't Know     Rough Estimate    Fairly accurate

Selection process
Pool demographics

If you have no idea about these percentages check Don't Know, if you are not very
sure of these numbers then check Rough Estimate or if you are sure check Fairly Accurate
Don't Know     Rough Estimate    Fairly accurate
  • Urban                          %
  • Suburban                    %
  • Rural                             %
  • Reservation                 %
  • Eligible for free lunch%
  • Home schooled           %
School demographics

If you have no idea about these percentages check Don't Know, if you are not very
sure of these numbers then check Rough Estimate or if you are sure check Fairly Accurate
Don't Know     Rough Estimate    Fairly accurate
  • Urban         %
  • Suburban   %
  • Rural             %
  • Reservation %
  • Public          %
  • Private         %
  • Charter         %
  • Parochial       %
  • Magnet         %
  • All Boys       %
  • All Girls         %
  • Coed             %
II Program Logistics

Location

Middle School campus
High School campus
College or University campus
Community center
Corporate site
Science center
If  campus, is it  residential  day camp
Contact with students is

For each identifiable program group (there may be only one for several programs, but others
have a variety of programs under one umbrella) please indicate the following:
(you could look at the example below)*


 

Program

Hours

Frequency

No of Sessions

o

o

o

o

o

o



*

Program

 Hours

 Frequency

 No of Sessions

1

2

Weekly

4

1

0.5

Daily

3

2

5

Monthly

2

This would be the entry if the meeting schedule is as follows:
Sub Program 1 :4 sessions weekly 2 hours each
Sub Program 1 :3 sessions daily of 1/2 hour each
Sub Program 2 :2 sessions monthly of 5 hours each

IV Costs and Funding

If you have no idea about these figures check Don't Know, if you are not very
sure of these numbers then check Rough Estimate or if you are sure check Fairly Accurate
Don't Know     Rough Estimate    Fairly accurate


Participants are charged tuition of        $

Number of scholarships available are 
To cover % of costs for      % of students who need it.
Participants are paid a stipend of         $

Administrators and teachers involved in program
Total Paid hours          hrs
Total Volunteer hourshrs

Activity costs

Materials          $
Transportation$
Food                 $
Lodging           $
Others             $
Source and extent of funding
Corporate sponsorship $
Federal grants                 $
State grants                     $
Institutional support     $
Other                               $


Recruitment efforts include
Mailing to school district(s)
Mailing to individual schools
Mailing to individual teachers
Mailing to homes of students
Recruitment visits to shcools
Phone calls to schools/districts/teachers
Other
Criteria
financial eligibility
expressed interest of student
recommendation(s) - from whom?
ethnicity
gender
grades
testscores
essay
III Program Content

Disciplines addressed

mathematics
biology
chemistry
physics
electrical engineering
mechanical engineering
chemical engineering
civil engineering
graphic design
computer science
computer applications
Other
Programs Include
carrer days
Site visits
visits by professors
skill building
Conferences
Internships
Mentoring
E-mail
Family Involvement
Community Involvement
Lectures
Labs
Take-home products:
   Tangible/carry away projects
   Virtual products(available remotely, e.g. on the web)