Stanislaus County Project SAFE Middle/Junior High After School Student Pre-Survey

1. How old are you?

How old are you? 11 years old, or younger

12-13 years old

14 years old, or older

2. Are you a boy or girl?

Are you a boy or girl? Boy

Girl

3. What grade are you in now?

What grade are you in now? 6th grade

7th grade

8th grade

4. What school do you attend?

What school do you attend?

5. Do you like coming to school?

Do you like coming to school? Always

Sometimes

Never

6. Do you feel safe in your After School Program?

Do you feel safe in your After School Program? Always

Sometimes

Never

7. Why are you going to this After School Program?

Why are you going to this After School Program? I don't want to be home alone

I like the program

It is a safe place to be

My parents want me to go

To get help with school work

8. Please mark whether you agree with each of the following statements: (mark all that are true)

Please mark whether you agree with each of the following statements: (mark all that are true) I don't know much about the after-school program

The after program has activities that we usually don't have during the day

The after-school program doesn't interest me

The program is a safe place to go after school

The after-school program helps with my homework

The students that attend the after-school program really like it

I do not attend the after-school program, but I would really like to

I feel comfortable talking to the staff in the after-school program

I have done things in the after-school program that make me proud of myself

I like going to the after-school program

I get to be a leader in the after-school program

9. What do you usually do after school is over?

What do you usually do after school is over? Homework or study

Get help with schoolwork from an adult (such as a tutor)

Take private classes or lessons such as art, music, or dance

Play or practice a sport

Hang out with friends (talking, playing games, going to the mall or a movie)

Watch TV or play video games

Do religious activities or get religious instruction

Other

10. What types of instruction and/or activities would you like to see in the after-school program? (Please rank your top 8 choices, only)

	Least	Most
Aerobic Exercise	What types of instruction and/or activities would you like to see in the after-school program? (Please rank your top 8 choices, only) Aerobic Exercise Least	Most
Art and Crafts	Art and Crafts Least	Most
Baseball/Softball	Baseball/Softball Least	Most
Basketball	Basketball Least	Most
Card and Board Games	Card and Board Games Least	Most
Cheerleading	Cheerleading Least	Most
Chess	Chess Least	Most
Community Service	Community Service Least	Most
Computer Club	Computer Club Least	Most
Cooking	Cooking Least	Most
Dance	Dance Least	Most
Drama	Drama Least	Most
Field Trips	Field Trips Least	Most
Gymnastics	Gymnastics Least	Most
Homework Help or Tutoring	Homework Help or Tutoring Least	Most
Junior Achievement	Junior Achievement Least	Most
Martial Arts	Martial Arts Least	Most
Music	Music Least	Most
Other	Other Least	Most
Painting	Painting Least	Most
Peer Counseling/Conflict Resolution	Peer Counseling/Conflict Resolution Least	Most
Photography	Photography Least	Most
Poetry Writing	Poetry Writing Least	Most
School Newspaper	School Newspaper Least	Most
Science Experiments	Science Experiments Least	Most
Soccer	Soccer Least	Most
Volleyball	Volleyball Least	Most
Woodworking	Woodworking Least	Most
Yoga	Yoga Least	Most

11. Any other comments:

Any other comments:

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