2018 Annual Affiliate Check-In
Welcome to the Annual Raising A Reader Affiliate Check-In Survey! Your thoughtful answers allow the National Office to improve Affiliate support, including Coordinator training, inter-Affiliate networking and fundraising.

The Check-In Survey consists of these two required actions:
*Complete the Check-In Survey
*Complete the Site Template Survey

Please answer the following questions thinking of your most recent completed program year. (e.g. School Year 2017-2018 or July 2017-July 2018)

The FINAL DEADLINE to complete and submit your Check-In Materials is December 14, 2018!

If you have any questions or concerns as you are working on the survey, please contact: Tymisha Sweet at tsweet@raisingareader.org or (650)-489-0609

Email address *
Affiliate Information
Affiliate Name *
Your answer
Affiliate Mailing Address *
Your answer
Affiliate Phone Number *
Your answer
Affiliate Website
Your answer
Main Coordinator Name *
Your answer
Main Coordinator Email Address *
Your answer
Has your organization implemented Raising A Reader for at least one full program year? *
Demographics
Referring to your last program year:
How many children did you serve ages 0-2?
Your answer
How many children did you serve ages 3-5?
Your answer
How many children did you serve in grades K -2?
Your answer
Estimate the percentage of children you served who were living in poverty?
Your answer
Select the racial demographics of the families you served:
Estimate the percentage of the families you served within each racial demographic. (Please list each racial demographic and make sure your answers sum to 100%)
Your answer
Select all home language(s) spoken by the families that you served:
Estimate, in percentage, the home languages of the Raising A Reader families that you served. (Please list each language and make sure your answers sum to 100%)
Your answer
Select all settings where RAR was implemented:
Were any of your implementing sites specifically designed to serve: (Please select all that apply)
Program Implementation
Referring to your last program year:
Implementers
Yes
NO
Did you hold an Implementer Kick Off Orientation?
Did you conduct site visits with your Implementers?
Did you provide your Implementers with a Refresher Training?
Parents
Yes
No
Did you hold a Parent Kick-Off Orientation?
Did you provide additional training for parents on interactive read-aloud techniques?
Library
Yes
No
Did you have a Blue Bag Event?
Did you pass out library card applications and/or information about the library?
Red Bag Routine
Yes
No
Did you rotate Red Book Bags?
If yes, how many weeks on average were Red Book Bags rotated into homes?
Your answer
Evaluation
How did you measure the impact of RAR?
What were the overall results (behavior changes, individual outcomes, etc.) of your Raising A Reader program evaluation?
Your answer
Funding and Expansion Plans
When does your fiscal year end? 
MM
/
DD
/
YYYY
During your last completed Program Year, how was your RAR program funded? (Please select Yes or No for each option below.)
Yes
No
Federal Government (Striving Readers, Head Start, Title 1, etc) )
Local Government (State and Municipal)
Contributed Revenue (Foundations, Corporations, Individuals, etc.)
In-Kind (Grant Funded through RAR)
List any additonal types of funding for your program :
Your answer
In the next 12 months, do you plan to expand your RAR program?
If yes, how many additional children do you anticipate serving next year?
Your answer
Feedback
What other programs did you implement in partnership with Raising A Reader?
What support can your program benefit from?
On a scale 1 to 5 how would you rate the Raising A Reader National Office services?
Not Satisfied
Satisfied
Do you have any comments or information that you would like to share with the National Office?
Your answer
A copy of your responses will be emailed to the address you provided.
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