Examining the Potential
for Community and Institutional Partnerships
to Prevent Violence against Women
APPENDIX III: INSTITUTIONS SURVEY

I - GENERAL INFORMATION

We would like to know about your institution (corporation, small business, service club, union) so that we can provide our members and other women' organizations in British Columbia with a framework for developing successful partnerships to prevent violence against women and profiles of potential institutions with which to partner. Please answer the following as thoroughly as possible.

1. Institution Name ............................................

2. Address....................................................

City................................. Province........................

Postal Code....................

Phone.......................
Fax........................
E-mail...................................

Web site...................................

3. (1) Please check all categories listed below that are responsible for allocating resources (funds, gifts-in-kind, secondment, etc.) to the voluntary sector; and (2) Contact Person, Title, Name of committee/trust (if applicable), and address and phone number, if different from above.

II - PAST & PRESENT PARTNERSHIPS

4. Have you ever, in the past or presently, developed a partnership with a non-profit and/or charitable organization?

[Yes] [No]

If [no], please explain why not________, then go to Question 15.

5. Describe your most successful partnership with a non-profit and/or charitable organization by providing the following information:

Partnership Title______

Partnership Goal(s)______

Name of Non-Profit______

Amount of Funding Donated $________ and/or Service/Product Donated__________

Duration_______

6. How was this partnership initiated? Please check all that apply:

7. Were any of the following included in your partnership? Please check all that apply:

8. How would you describe this partnership? Please check all that apply:

9. How was your institution involved? Please check all that apply:

Was not directly involved other than providing funding and requesting a final report

Involved in developing the project from the beginning, including developing goals and objectives

Provided services, please list______

Provided volunteers, please describe_______

Other, please describe______

10. Describe any problem(s) your institution encountered with its partnership.

11. What benefits did you receive or did your institution expect to receive from this partnership? Please list in order of importance.

12. Do you feel the recognition of your support was sufficient? [Yes] [No]

If [No], please explain why not and what further recognition you would have liked.

13. Have you had a partnership that was not successful? [Yes] [No]

14. Please describe this partnership and why you felt is was not successful.

III - PARTNERSHIPS FOR THE FUTURE

15. Would your institution be interested in partnering with a women's organization to prevent violence against women? [Yes] [No] [Maybe]

If [Yes], please indicate what you would hope to gain from partnering with a women's organization?

If [No], Why not?

16. Please check all the forms of support you might consider providing in a partnership with a women's organization:

Cash donations:

Non-cash donations:

17. Please check all the types of activities and/or needs you would be interested in supporting in a partnership with a women's organization. 18. Do you have written guidelines and/or procedures concerning partnerships with non-profit organizations?

If [Yes], please attach a copy to this questionnaire.

If [No], please specify any particular guidelines or procedures your institution would like non-profits to consider in a partnership with your institution.

19. How often does your institution review and change its giving interests?

20. How would your institution like to be approached? 21. When considering partnering with a non-profit organization how would you rate each of the following statements on a scale from one to four: one (1) representing very important, and four (4) representing not very important to your institution.

The non-profit and/or charitable organization:

The request for support:

Your institution would support a non-profit or charitable organization:

22. Now we would like to ask you questions about some of your policies and practices. Some women's organizations may deem some of these important when choosing with whom to partner, while others may not. (1) Please circle [Yes], [No], or [N/A] (not applicable) for each statement below that applies to your institution.

Our institution:

23. With whom would your institution be willing to develop a partnership? Check all those that apply.

Please attach a copy of your most recent annual report, giving guidelines and procedures for partnering with non-profit organizations.

Please sign and date this form allowing us to develop a profile of your institution based on the information you have shared with us in this questionnaire. This profile will serve women's organization in developing future partnerships.

Signature_____________________ Date_____________

Title_________________________ Thank You.

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