Questionnaire for Interview/Survey

Social Problems Service Learning Project, Spring 2019

Student: Copy or print this document three times and use a different document for each person that
you interview. People to be interviewed:

 staff member
 volunteer
 client or another staff member

Student: Read these statements to the interviewee:

 I am observing and interviewing people in this organization for a course on social

problems. In this course, I have been studying the causes and effects of

______________________________________________.

 The information that you give me will remain anonymous. It will go directly to my

instructor with no name or identifying information attached to it.

 I will not publish your information in any form.

 I will not share your answers to the questions with anyone else at the

organization or outside of the course I am taking.

 If you have questions or concerns regarding my study, please contact the

instructor at yvonne.simerman@nscc.edu or 615.353.3482.

 Thank you for being willing to participate in this survey. I have approximately 15

questions. If you are uncomfortable responding to any of them, you may certainly

state your concerns and decline to answer.

Student: Ask these questions and record the answers that each person gives:

1. What is your position in the organization? Are you a member of the staff, volunteer or client?

2. How long have you been involved with this organization?

3. From your perspective, what is the main mission or goal of this organization?

4. Do you agree with the mission or goal of the organization? Why?

5. What are possible misconceptions about the mission or goal of the organization?

6. What programs does it offer to people?

7. Which of the programs in the organization is most successful at meeting its goals? Focus on
the programs you know something about.

8. What programs in the organization need to be improved or what could be added to meet the
goals of the organization? Focus on the programs that you know something about.

9. What are symbols (i.e. logo, name, quote) which the organization uses to promote its
mission?

10. What does this symbol mean to you? How does it reflect the mission of the organization?

11. For my course, I am studying the problem of _____. How does this organization try to solve
problem?

12. In your opinion, what causes the problem of _____?

13. In your experience, what are the effects of the problem? (emotional, financial, physical, etc.)