Washington Elementary 21st CCLC Needs Assessment

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* 1. How does your child spend his/her time afterschool? (Choose 1-2)

Completing homework

Taking care of family member(s)

Watching TV or playing video games

Participating in afterschool activities

Other (please specify)

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* 2. Does your child require help completing homework afterschool?

Yes

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* 3. If your child attends an afterschool program, how often does he/she participate during the week? (Choose 1)

4-5 times per week

2-3 times per week

1 time per week

A few times per month

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* 4. If your child does not attend afterschool program, please explain reasons why. (Choose 1-2)

Not offered by the school

Programs are too expensive

Lack of transportation

Conflicts with sports or other activities

Takes care of family member(s) after school

Other (please specify)

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* 5. How often does your child participate in sports or physical activities (for more than 30 minutes) outside of school (including weekends)? (Choose 1)

4-5 times per week

2-3 times per week

1 time per week

A few times per month

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* 6. Has your child ever witnessed, or has been a subject to, bullying at his/her school?

Yes (If yes, please explain below)

I don’t know

Comments (please specify)

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* 7. How important are the following activities/services for an afterschool program?

	Very Important	Somewhat Important	Neither Important nor Unimportant (Neutral/No Opinion)	Not Very Imporant	Unimportant
Language skills and academic enrichment	Language skills and academic enrichment Very Important	Language skills and academic enrichment Somewhat Important	Language skills and academic enrichment Neither Important nor Unimportant (Neutral/No Opinion)	Language skills and academic enrichment Not Very Imporant	Language skills and academic enrichment Unimportant
Mathematics and science education	Mathematics and science education Very Important	Mathematics and science education Somewhat Important	Mathematics and science education Neither Important nor Unimportant (Neutral/No Opinion)	Mathematics and science education Not Very Imporant	Mathematics and science education Unimportant
Homework help	Homework help Very Important	Homework help Somewhat Important	Homework help Neither Important nor Unimportant (Neutral/No Opinion)	Homework help Not Very Imporant	Homework help Unimportant
Career exploration	Career exploration Very Important	Career exploration Somewhat Important	Career exploration Neither Important nor Unimportant (Neutral/No Opinion)	Career exploration Not Very Imporant	Career exploration Unimportant
Arts and music education	Arts and music education Very Important	Arts and music education Somewhat Important	Arts and music education Neither Important nor Unimportant (Neutral/No Opinion)	Arts and music education Not Very Imporant	Arts and music education Unimportant
Service learning projects	Service learning projects Very Important	Service learning projects Somewhat Important	Service learning projects Neither Important nor Unimportant (Neutral/No Opinion)	Service learning projects Not Very Imporant	Service learning projects Unimportant
Nutrition, wellness and health	Nutrition, wellness and health Very Important	Nutrition, wellness and health Somewhat Important	Nutrition, wellness and health Neither Important nor Unimportant (Neutral/No Opinion)	Nutrition, wellness and health Not Very Imporant	Nutrition, wellness and health Unimportant
STEM Activities	STEM Activities Very Important	STEM Activities Somewhat Important	STEM Activities Neither Important nor Unimportant (Neutral/No Opinion)	STEM Activities Not Very Imporant	STEM Activities Unimportant
Character education	Character education Very Important	Character education Somewhat Important	Character education Neither Important nor Unimportant (Neutral/No Opinion)	Character education Not Very Imporant	Character education Unimportant

Other (please specify)

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* 8. Which family activities/services would you be interested in and/or willing to attend?

	Yes, definitely	Very likely	Neither Important Nor Unimportant (Neutral/No Opinion)	Not likely	No, I would not attend
Family Nights	Family Nights Yes, definitely	Family Nights Very likely	Family Nights Neither Important Nor Unimportant (Neutral/No Opinion)	Family Nights Not likely	Family Nights No, I would not attend
Student Showcase	Student Showcase Yes, definitely	Student Showcase Very likely	Student Showcase Neither Important Nor Unimportant (Neutral/No Opinion)	Student Showcase Not likely	Student Showcase No, I would not attend
Family Fitness Activities	Family Fitness Activities Yes, definitely	Family Fitness Activities Very likely	Family Fitness Activities Neither Important Nor Unimportant (Neutral/No Opinion)	Family Fitness Activities Not likely	Family Fitness Activities No, I would not attend
Resume Workshops	Resume Workshops Yes, definitely	Resume Workshops Very likely	Resume Workshops Neither Important Nor Unimportant (Neutral/No Opinion)	Resume Workshops Not likely	Resume Workshops No, I would not attend
Financial Literacy Workshops	Financial Literacy Workshops Yes, definitely	Financial Literacy Workshops Very likely	Financial Literacy Workshops Neither Important Nor Unimportant (Neutral/No Opinion)	Financial Literacy Workshops Not likely	Financial Literacy Workshops No, I would not attend

Other (please specify)

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* 9. What would prevent you from participating in family engagement events? (Choose 1-2)

Lack of child care

Schedule conflict

Lack of transportation

Activities are not interesting or engaging

Other (please specify)

Washington Elementary 21st CCLC Needs Assessment - Parent Survey

Please complete this brief survey!

Question Title

* 1. How does your child spend his/her time afterschool? (Choose 1-2)

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* 2. Does your child require help completing homework afterschool?

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* 3. If your child attends an afterschool program, how often does he/she participate during the week? (Choose 1)

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* 4. If your child does not attend afterschool program, please explain reasons why. (Choose 1-2)

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* 5. How often does your child participate in sports or physical activities (for more than 30 minutes) outside of school (including weekends)? (Choose 1)

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* 6. Has your child ever witnessed, or has been a subject to, bullying at his/her school?

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* 7. How important are the following activities/services for an afterschool program?

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* 8. Which family activities/services would you be interested in and/or willing to attend?

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* 9. What would prevent you from participating in family engagement events? (Choose 1-2)

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* 10. Please provide three recommendations for services, partners, or activities that should be part of the 21st Century Community Learning Center: