Exit this survey C.A.R.E. 21st CCLC Participant Survey Fall 2018 Default Section Question Title * 1. Date Question Title * 2. School Question Title * 3. Grade Question Title * 4. Do you like going to school? All of the time Most of the time Some of the time Never Question Title * 5. Do you feel safe attending the after school program? All of the time Most of the time Some of the time Never Question Title * 6. How often are you absent from school? Often (10 or more days a year) Sometimes (5-10 days a year) Rarely (once or twice a year) Never Question Title * 7. Do you study hard for tests? All of the time Most of the time Some of the time Never Question Title * 8. How often are you in trouble during the school day? All of the time Most of the time Some of the time Never Question Title * 9. Do your parents talk to you about school or homework? All of the time Most of the time Some of the time Never Question Title * 10. Do you feel comfortable talking to teachers and after school staff? All of the time Most of the time Some of the time Never Question Title * 11. Does the after school program support a sense of belonging? All of the time Most of the time Some of the time Never Question Title * 12. Does after school staff encourage your ideas and feedback regarding the program? All of the time Most of the time Sometimes Never Question Title * 13. How often do you turn your homework in on time? All of the time Most of the time Some of the time Never Question Title * 14. Do you look forward to coming to school? All of the time Most of the time Some of the time Never Question Title * 15. How often do you feel upset when you come to school? All of the time Most of the time Some of the time Never Question Title * 16. Have you felt happier or less stressed since attending the after school program? Always Most of the Time Some of the Time Never Question Title * 17. How well do you get along with others, including other students or adults? Very well Fair, could be better Not well at all Question Title * 18. Rate your self-esteem (i.e. how do you think of yourself?): High Medium, or up and down Low Question Title * 19. How are your grades? Very high Above average Average Below average Failing Question Title * 20. Have you ever been held back a grade or had to repeat a year? Yes No Question Title * 21. Are there any classroom subjects in which you feel you need extra help improving your grades? (Check all that apply) Math English/Reading Science Social Studies None Question Title * 22. Before joining this program, had you ever participated in a before-school or after-school program? Yes No Question Title * 23. What do you usually do after school? (check all that apply) Watch TV Video/computer games Babysitting Go to babysitters' Play with friends Board Games Play Sports Work on hobbies Read Art Martial Arts Work Chores Do homework Spend time with family Eat snacks Skateboard Go to the mall Participate in an after school program Participate in science/nature programs Other Question Title * 24. What would you like to do in an after-school program? Done