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* 1. Which school does your child (children) attend?

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* 2. What is your child's current grade (or grades if more than one child)?

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* 3. How many children do you have attending Madison Parish Schools?

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* 4. Do you have after school care for your child other than a family member?

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* 5. Are you still at work when your child comes home from school?

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* 6. Do you think your child needs additional help with homework to make better grades?

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* 7. Would you allow your child to participate in after school, Saturday, or summer programs to improve his or her grades?

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* 8. What after school academic or recreational opportunities would you like to see your child attend?

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* 9. Do you have a computer connected to the Internet at your home?

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* 10. Do you have Internet at a nearby library or community center that you and your child may access?

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* 11. Do you think that providing students with after school programs will decrease drug use, teen pregnancy, and the crime rate in your Parish?

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* 12. Do you think that after school tutoring and homework assistance will help your child make better grades?

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* 13. Do you think your child will graduate from high school?

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* 14. Do you think your child will attend college?

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* 15. Are you interested in completing your high school diploma through the G.E.D. program?

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* 16. Are you interested in taking classes to increase your job skills through the community college?

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* 17. Did you know that you can receive financial assistance to take classes at the college to increase job skills?

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* 18. Which classes would you like to see offered to parents at the Madison Parish School District? (Check as many as you wish).

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* 19. Would you volunteer to help in an after school program?

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* 20. Which skills could you contribute in an after school, Saturday, or summer program for youth and parents.

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* 21. What is the greatest need for services/programs for children in your community:

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* 22. Will your child (or children) attend the Madison Parish 21st Century Community Learning Center after school program?

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