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* 1. How would you rate your child's after-school program in the following areas?

  Poor Fair Good Excellent Don't know/Not applicable
The overall after-school program
The safety of your child while he/she is at the program
The atmosphere and comfort of the room(s) where the program operates
The snacks that are served to your child on a daily basis
The hours of operation
The transportation provided, if any

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* 2. To what extent to you agree or disagree with the following statements about the program?

  Strongly Disagree Disagree Agree Strongly Agree Don't know
I am satisfied with the kinds of programs and activities offered at the after-school program.
There is adequate quiet time for my child to complete homework.
The after-school program has helped my child get his/her homework done on time.
There is adequate opportunity for physical activity.

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* 3. Why does your child attend the after-school program?

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* 4. To what extent to you agree or disagree with the following statements describing your child's experience in the after-school program? My child...

  Strongly Disagree Disagree Agree Strongly Agree Don't know
Enjoys attending the after-school program.
Feels comfortable with the after-school staff.
Seems happier or less stressed since participating in the after-school program.
Has friends in the after school program.
Completes homework with greater ease.
Has a better attitude toward school

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* 5. To what extent do you agree or disagree with the following statements about the after-school staff?

  Strongly Disagree Disagree Agree Strongly Agree Don't know
I am comfortable talking with the staff.
The staff welcomes suggestions from parents.
The staff keeps me informed about my child's day at the after-school program.
The staff welcomes parents who wish to observe.
I am comfortable with how the staff handles discipline problems.
The staff encourages positive interactions among the children.
I am satisfied with the number of adult staff available to work with the students.
The after school staff interacts with students in positive ways.
The staff has clearly informed me about how to contact them during the after-school program.
I am satisfied with the overall performance of the after-school program.

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* 6. Have you been involved as a volunteer in the after-school program?

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* 7. Since beginning the program, have you noticed any improvements in your child's...

  Yes No
Behavior
Grades
Self-Esteem
Motivation
Homework completion

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