Section A: Site Specifics
Please have this section filled out by someone in the organization familiar with this information. This person need not be the same person who responds to sections B & C. You may replace this section with organizational literature (such as an annual report to donors) if it contains this information&endash;please send this information with completed sections B & C.

The site questions are intended to provide an understanding of the places where certain types of materials are being used. These responses will be kept confidential.

Name of organization ______________________________________________________

Address _______________________________________________________________

_______________________________________________________________

_______________________________________________________________

Phone # _____________________________ Fax # _____________________________

Email address ___________________________________________________________

Website URL ____________________________________________________________

Describe the general focus of your organization or your mission statement if you have one:

Type of organization (check all that apply):

___ Learning center ___ Free standing literacy program ___ Workfare Investment Program

___ Prison with educational options ___ Social Service organization with adult ed./literacy component

____ Adult Education / literacy located in a public library but not sponsored by the library

____ Adult Education / literacy sponsored by the public library

____ Adult Education / literacy connected to public school system

____ Adult Education connected to&endash; a) ___ community college; or b) ___ a university/ 4-year college

____ Alternative/Transitional Housing facility with an adult education / literacy component

____ Other (please be as specific as possible)

Who do you serve?
Please provide percentages if available or simply check off all that apply.

Education Levels: Completed 5th grade or lower _____ Completed 5th-12th grade _____ Graduated from High School _____ Attend College or Tech School _____   Current Program Enrollment: ABE (Adult Basic Ed) _____ ESL (English as 2nd Language) _____ Pre-Beginning or Beginning _____ Basic Skills _____ Pre-GED _____ GED _____ College Enrolled _____   Gender: Women _____ Men _____

Citizenship & Race or Origin: US Born European-American _____ African-American _____ Hispanic-American _____ Asian-American _____ American Indian _____ Arab-American _____ Other: _____ Immigrant East/West Europe _____ African Countries _____ Central/South Amer. _____ East/South/Pacific Asian _____ Indigenous non US _____ Middle Eastern _____ Slavic/Russian _____ Other: _____ Language: English-speaking only _____ Multilingual _____

Economic Status: TANF ("welfare") _____ Workfare Program _____ Homeless _____ Working Poor _____ Disability Income _____ Veteran Income _____ Other: (Describe) _____

Age Range: 16-20 _____ 21-31 _____ 31-40 _____ 41-50 _____ Older than 50 _____ Any additional information you'd like to add that you think is important for this study?

 Go to Section B.