Below are some questions about how you feel about yourself and the afterschool program you work for. Please answer each question honestly. This survey is anonymous. If you don't want to answer a question, skip it.

1.Name of Program:

*2.Site Address(Required.)

Site Name (school, community center etc.)

Address

City/Town

State/Province

ZIP/Postal Code

3.How many years have worked in the afterschool field?

4.On average during the school year, how many hours per week do you work in this program?

5.On average during the school year, how many hours per week do you work directly with youth?

6.In addition to working directly with youth, are you also a program coordinator or manager?

Yes

No

7.Which language(s) are you comfortable speaking and/or teaching in?

English

Mandarin or Cantonese

Russian

Spanish

Vietnamese

Other (please specify)

8.Which language(s) do you use on a regular basis in this program?

English

Mandarin or Cantonese

Russian

Spanish

Vietnamese

Other (please specify)