Chaplaincy and Volunteer Services Division

Volunteer Program Assessment/Suggestion Form

Facility Name:

Program Name:

Volunteer Name:

Please indicate on the scale below your level of agreement/disagreement with the following statements. A rating of 1 indicates that you disagree with the statement; a rating of 5 indicates that you agree. Space is provided at the bottom of this form for additional comments.

1. My volunteer assignment is satisfying and meaningful. Disagree 1 2 3 4 5 Agree

2. My volunteer service is effective. Disagree 1 2 3 4 5 Agree

3. My qualifications are well matched to the task. Disagree 1 2 3 4 5 Agree

4. Training provided adequate preparation and guidelines. Disagree 1 2 3 4 5 Agree

5. Staff is supportive and treats me as a team member. Disagree 1 2 3 4 5 Agree

6. Department/Division staff provide clear guidelines. Disagree 1 2 3 4 5 Agree

7. Department/Division staff are available and helpful to answer questions and provide instruction as needed. Disagree 1 2 3 4 5 Agree

8. The unit/office is prepared for my visits. Disagree 1 2 3 4 5 Agree

9. How long have you served as a volunteer? Years: Months:

10. How frequently do you report as a volunteer? weekly q10_wky monthly q10_mny other
q10_oth If other, specify:

Please answer the following questions. If a question does not apply, please type N/A.

11. On average, how many hours do you spend on each volunteer visit?

12. What have you enjoyed least about your volunteer assignment?

13. What have you enjoyed most about your volunteer assignment?

14. What changes would help improve your assignment?

15. What other volunteer assignments would be of interest to you?

Additional Comments:

Volunteer Program Area: Chaplaincy
Substance Abuse Treatment Program
Windham School District
Sex Offender Treatment Program
Parole Division
Victim Services
Student Intern
TTC/Halfway House

I verify that I have completed this application and that the information it contains is true.

Notice: With few exceptions, you are entitled upon request: (1) to be informed about the information the Texas Department of Criminal Justice (the Agency) collects about you; and (2) under Texas Government Code §§552.021 and 552.023, to receive and review the collected information. Under Texas Government Code §559.004, you are also entitled to request, in accordance with the Agency's procedures, that incorrect information the Agency has collected about you be corrected.

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