General Questions and Demographics

We would like to know a bit about you and the setting you work in. 

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* 1. Full written name of your Institution

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* 2. What is the total enrollment for your institution?

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* 3. Is your institution:

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* 4. What type of institution is yours: 

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* 5. Is your institution a current member of AUCCCO?

This Survey is focused on the role, demographics, and responsibilities of the person ultimately responsible for the oversight and direction of outreach. Please respond accordingly.

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* 6. Are you the person primarily tasked with the overall oversight of Outreach at your center?

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* 7. If yes, what is your current title/role?

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* 8. If no, what is the title of the person ultimately responsible with oversight of Outreach?

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* 9. How many years have you been in this position?

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* 10. Does your center/agency include a leadership/manager level position to oversee Outreach?

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* 11. For the person primarily tasked with oversight of Outreach, in what range does their salary fall?

For the next set of questions, this survey is interested in the identity of the person primarily tasked with oversight of Outreach. This may be you.

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* 12. The person primarily tasked with Outreach identifies as:

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* 13. The person primarily tasked with Outreach identifies as:

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* 14. The person primarily tasked with Outreach identifies as:

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* 15. What is the discipline for the person primarily tasked with oversight of Outreach?

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* 16. What is the degree for the person primarily tasked with oversight of Outreach?

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* 17. Does the person primarily tasked with Outreach hold a professional license?

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* 18. If yes, you hold a professional license:

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* 19. Is your College/University considered a Minority Serving Institution as part of any of these programs?

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* 20. If you are a Minority Serving Institution, please specify:

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* 21. How many FTEs (Full Time Employees) do you have in your Center?

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* 22. Do you have contractual staff (part-time/hourly)?

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* 23. If yes, how many:

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* 24. Who at your center provides Outreach? Check all that apply

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* 25. Is outreach at your center considered a direct service or an “extra” separate from other services? By direct service, we are asking if this is part of your work responsibilities/productivity or a service provided in addition to these responsibilities.

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* 26. If your center uses the Clinical Load Index from CCMH, do you include Outreach services?

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* 27. Are Outreach activities reported as productivity or counted by your institution’s means of tracking direct service capacity?

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* 28. As an entire Center (staff, interns, trainees, etc...), what estimated percentage of time does your center invest in outreach activities?

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* 29. What percentage of staff at your center have a formal outreach requirement or allotted time to provide Outreach services?

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