MBK Community Challenge Survey

Section 1: General Information

I am completing this survey on behalf of the following MBK Community:

Tribal Nation (if applicable):

City/County

State

Mayor, Tribal Leader or County Exec.:

Title

First Name

Last Name

E-mail

Phone

Primary MBK POC

First Name

Last Name

Organization

Title

E-mail

Phone

Secondary POC:

First Name

Last Name

Organization

Title

E-mail

Phone

Contact Information that will be shared on the MBK Website:

First Name

Last Name

Organization

Title

E-mail

Phone

URL/Website

Section 2: MBK Requirements

Local Action Summit

Yes

No

If yes, please enter the date the summit was held. If no please enter the tentative date

Formed MBK Task Force/Committee

Yes

No

If yes, please list members’ names and titles. If no, please provide a brief status update on the formation of the task force

Local Action Plan Status Released

Yes

No

If yes, what is the URL where the public can read the Action Plan:

If no, please enter a tentative release date

Does your MBK Community have an assigned director?

Yes

No

If yes, are they full time or part time?

Section 3: Funding

Please enter the percentage of funding for your MBK initiative that is:
Enter a percentage between 0 – 100 for each

A. Public (federal, state, or municipal/county funding)

B. Private Foundations

C. Public Charities

D. Individual Donations

Please enter percentage that comes from another source, and note the source.

If you receive public funding to support your MBK initiative, what percentage of the funding is:
Enter a percentage between 0 – 100 for each

A. Federal

B. State

C. Municipal

D. County

Please enter percentage that comes from another source, and note the source.

Is your MBK Community’s work funded for more than one year?

Yes

No

What is your total MBK budget for the current year?

What percentage of your total MBK budget goes to administrative overhead?

What percentage of your total MBK budget goes to programming?

Section 4: MBK Milestone Emphasis

Please indicate the emphasis of your current work locally on the various MBK milestones

	No emphasis	Slight emphasis	Moderate emphasis	Strong emphasis	Very strong emphasis
Getting a healthy start and entering school ready to learn
Reading at grade level by third grade
Graduating from high school ready for college and career
Completing post-secondary education or training
Successfully entering the workforce
Keeping kids on track and giving them second chances
Mentoring and caring adults

Please rate the extent to which you agree with the following questions about your MBK Community Challenge initiative:

	Strongly Disagree	Disagree	Neutral/No Opinion	Agree	Strongly Agree
Youth have regular opportunities to engage with MBK programs.
Community members know how they can support our local MBK initiative.
Leadership is shared between local government and community leaders.
The school system is an engaged partner.
Local leadership is involved and bought into the work.
We have clear goals and a transparent method to track and showcase progress.
There have been positive changes to state and/or local policy affecting boys and young men of color and other vulnerable youth as a result of our MBK initiative.
We are meeting expectations and goals in our MBK Action plan on schedule.
The MBK Community Challenge has helped our community accelerate progress on challenges facing boys and young men of color and other vulnerable youth.
Our MBK Community Challenge initiative has adequate funding, leadership and infrastructure to meet our goals and promote long-term success.
Our MBK Community Challenge initiative is making a meaningful difference in the lives of youth in our community.

Section 5: Successes and Supports

List 3-5 of your most significant outcomes (Please be sure to list specific outcomes including numbers impacted, etc. and include links to articles, if available).