Division Self-Assessment Questionnaire - ULSTL

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What We Do
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Division Self-Assessment Questionnaire

Your Information

* Indicates required field

Name *

First

Last

Title *

Email *

UL Number *

Mobile Number *

Division Information

Division Name *

# of Departments in the Division *

Main Location Address (No periods or special characters) *

Line 1

Line 2

City

State

Zip Code

Country

Branches (List All) *

Total Budget by Department (List All) *

Total Budget for Division *

Total # of Staff *

Full Time - Permanent *

Full Time - Temporary *

Part Time *

Need of Volunteers *

Yes No

Required # of volunteers to run program/project/ Service, and/or activity *

Program(s), Project(s), Service(s), Activity(ies) offered by Division

List all by department - (indicate if it is program/project/ Service, and/or activity) *

Current Funding Sources

Funding Types (Select all that apply) *

Federal Grant State Grant Local Grant - City Local Grant - County Foundation Donations Other

Start Date & End Date (Please list the Names & Dates of all funding provided) *

Reporting Requirements
(Select all that apply)

Reporting Type *

Programmatic Financial Other (if other please list below)

Other Reporting Type *

Report Submitted To *

National Urban League United Way ARCHS CDA Other (if other please list below)

Other Report Submitted To Type *

Reporting Period *

Weekly Monthly Quarterly Yearly Other (if other please list below)

Other Reporting Period Type *

Data Management System
(Select all that apply)

System Types *

Apricot - Fully Trained Apricot - Partially Trained Apricot - No Training ChildPlus - Fully Trained ChildPlus - Partially Trained ChildPlus - No Training UWASIS - Fully Trained UWASIS - Partially Trained UWASIS - No Training CounselorMax - Fully Trained CounselorMax - Partially Trained CounselorMax - No Training MOWAP - Fully Trained MOWAP - Partially Trained MOWAP - No Training Attendance on Demand - Fully Trained Attendance on Demand - Partially Trained Attendance on Demand - No Training Other (specify)

Other Data Management System Check *

Communications

Internal Communication System: *

Email Phone Text Department Meetings

How Often for Each (Internal Communication System) *

Agency-Wide Communication System: *

Email Phone Text Standard Meetings

How Often for Each (Agency-Wide Communication System) *

External Communications: *

Media Protocol Observed *

Yes No Not Aware of

Approval Process: (Name of Responsible Person)

Payroll *

Vacation *

Requisitions *

Other *

Inventory

# of Vehicles *

# of LapTops *

# of UL Mobile Phones *

Other (List and Number) *

Form 101
Rev 7/1/2021

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