Fall Parent Questionnaire

You are invited to complete this short questionnaire about the afterschool program. Your response will be kept confidential, so please do not write your name. Your feedback will help us improve our program. By completing and returning this survey, you agree to participate in this study. If you have more than one child in the program, please just complete one survey and think about all of your children when answering questions.

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* 1. Students Name (optional)

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* 2. How much do you agree with the following statements about the 21st Century Community Learning Center afterschool Program?

  Strongly Disagree Disagree In the Middle Agree Strongly Agreee
Students feel welcome in the program.
The rooms used for the afterschool program are safe and clean.
The rules are clear and fair.
Staff treats students with respect.
Staff listens to what students have to say.
It is easy for students to make friends in the program.
Students have input into what kind of activities are provided
The activities are fun and engaging for students.
Most students have good attendance in the program.
The program provides enough opportunity for students to complete homework.
The activities are designed to help students do better in school.
The program helps students apply what they learn in school.
The afterschool program staff and school-day staff communicate with each other.
Overall, I am happy with the program.
Afterschool staff involve parents in decision making and planning about activities.
Afterschool staff communicate well with parents.
Parents feel welcome in the program.

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* 3. Since attending the 21st CCLC afterschool program, has your child declined, stayed the same, or improved in the following areas?
Note: If he/she did not need to improve, please select that option.

  Did not need to improve Declined Stayed the same Improved
Grades
School attendance
Ability to make friends
Preparation for school
Classroom behavior
Homework completion
Parents and families do many different things when they are involved in they children's education. We would like to know how true the following things are for you and your family.  Please think about the fall school semester (August to December) as you read and respond to each item

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* 4. An adult (parent or other caregiver) in our family...

  Never One or two times a semester At least once every month Two to three times a month Once a week A few times a week Daily
....Talks with this child about the school day.
...Supervises (or reviews) this child's homework.
...Helps (or encourages) this child to study for tests.
...Helps (or encourages) this child to complete homework assignments.
...Make sure this child completes his/her homework.
...Reviews this child's grades on assignments and tests.
...Helps (or encourages) this child to practice math skills.
...Helps (or encourages) this child to practice reading or writing skills.
...Encourages this child to check out library books.
...Encourages this child to read for fun.
...Suggests reading materials to this child.
...Participates in reading activities with this child (e.g., talks with the child about what the child is reading, reads with the child)

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* 5. During this past semester, have you attended any family programs (e.g., family nights, activities) at your child's school?

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* 6. What do you like most about the afterschool program?

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* 7. How can we make the afterschool program better?

Thank you for taking the time to complete this questionnaire.  We appreciate your feedback!

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