21st CCLC 2016-2017 Parent Survey Question Title * 1. Name of student in 21st CCLC program: Question Title * 2. *The program is helping my child’s behavior improve. (Choose One) Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Question Title * 3. *The program is helping my child to complete and turn in his/her homework on time. (Choose One) Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Question Title * 4. *How satisfied are you with your child's 21st CCLC program? (Choose One) Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Question Title * 5. Prior to your child participating in the 21st CCLC program, where did your child usually go after school? (Choose One) My child stayed home alone. My child stayed home with a sibling, parent, guardian, or sitter. My child went to the home of someone else (like a friend, relative, or sitter). My child went someplace else for activities. Other (please specify) Question Title * 6. How did you find out about the 21st CCLC program? (Choose One) From the school or agency. From another parent. From another community organization or agency. From another student. Other (please specify) Question Title * 7. The program is helping my child’s reading skills improve. (Choose One) Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Question Title * 8. The program is helping my child’s math skills improve. (Choose One) Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Done
