DATA COLLECTION FORM FOR DETAIL SHEET #10

Using a scale of 0-3, please rate the degree to which your grant program has incorporated the following cultural/linguistic competence elements into your policies, guidelines, contracts and training.

Please use the space provided for notes to describe activities related to each element, detail data sources and year of data used to develop score, clarify any reasons for score, and or explain the applicability of elements to program.

0 1 2 3 Element
        1. Strategies for advancing cultural and linguistic competency are integrated into your program's written plan(s) (e.g., grant application, recruiting plan, placement procedures, monitoring and evaluation plan, human resources, formal agreements, etc.).
        2. There are structures, resources, and practices within your program to advance and sustain cultural and linguistic competency.
        3. Cultural and linguistic competence knowledge and skills building are included in training aspects of your program.
        4. Research or program information gathering includes the collection and analysis of data on populations served according to racial, ethnic, and linguistic groupings, where appropriate.
        5. Community and family members from diverse cultural groups are partners in planning your program.
        6. Community and family members from diverse cultural groups are partners in the delivery of your program.
        7. Community and family members from diverse cultural groups are partners in evaluation of your program.
        8. Staff and faculty reflect cultural and linguistic diversity of the significant populations served.
        9. Staff and faculty participate in professional development activities to promote their cultural and linguistic competence.
        10. A process is in place to assess the progress of your program participants in developing cultural and linguistic competence.

0=Not Met
1=Partially Met
2=Mostly Met
3=Completely Met
Total the numbers in the boxes (possible 0-30 score) __________

NOTES/COMMENTS: