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* 1. How would you describe our local need for after school programs?

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* 2. How would you rank our need to provide students with homework assistance?

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* 3. At What grade levels are after school programs most important?

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* 4. How likely would your family make use of after school programs?

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* 5. If your family is likely or highly likely to participate in after school programs, how many of your children would attend?

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* 6. Parent's name, child's name, and grade that would be attending?

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