1.

The purpose of this survey is to determine how much your attendance at the various parenting related events will or has helped you with your child (ren). Unless indicated otherwise, please select only one answer for each question.  You may choose to skip a question but please answer all of the demographic questions (1-8).

* 1. Test Type

* 2. Date of Survey Completion?

Date
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Demographics: In this section we are asking you to tell us about yourself.  The information that you provide will be kept confidential and private. Results will be summarized and reported as group data and your identity or any of your personal information will be kept private to the extent provided by the law.

* 3. What school does your child attend?

* 4. What is your Child's Student Identification Number (if you have more than one child enrolled in the 21st CCLC program list each of them; please do not list children not enrolled in the program)?

* 5. What is your age today?

* 6. How many children live in your home?

* 7. What is your gender?

* 8. What is your highest level of education?

* 9. I am a caregiver for the following person (Mark all that apply).

* 10. How do you describe yourself?

* 11. What is your job status (Mark all that apply)?

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