We would like to have feedback from YOU. This information will help us understand a bit more about you and help us to improve the program.

* 1. Test Type

* 2. What school do you attend?

* 3. What is your name?

* 4. What is your Student Identification Number?

* 5. What is today's date?


* 6. What is your age today?

* 7. Are you a boy or girl?

* 8. What grade are you in?

* 9. How do you describe yourself?

* 10. Do you attend the Afternoons Rock (21CCLC Program) after school program?

* 11. Instructions: Please select the answer that best tells how you think and feel.

Strongly Disagree




Strongly Agree
A. I do art work when I’m not at school (coloring, drawing, painting, dancing, playing musical instruments, performing, etc…).
B. I look at my friends’ art work (drawings, paintings dance routines, songs, performances, etc…) and talk about it with them.
C. I see myself as an Artist (painter, dancer, actor, musician, etc…).
D. I use my family traditions/culture/heritage to help create my art (paintings, dance routines, songs, etc...).
E. I like to show my art work (paintings, drawings, sculptures, etc...) or perform them (dance routines, songs, theater roles, etc...) for others.
F. I like to use my art to make friends with other people
G. I use my art to tell/show others how I feel.
H. I feel excited when I am making art or performing.
I. I am able to express who I am through my art work.

* 12. Since the beginning of the school year, which one of the above questions (A-I) have you improved in the most and how?

* 13. What arts activity or projects have you participated in during the after school program?