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* 2. *If you would like to enter for a chance to win a $50 gift card, please indicate your name.

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* 3. Please read each statement carefully and indicate your level of agreement in the columns on the right.  Please select which level of agreement clearly reflects your response.  If you have no experience with the subject of the statement, mark "No Opinion."

  Strongly Agree Agree Disagree Strongly Disagree No Opinion
I feel that I have a clear understanding of the Program's goals and objectives.
The Program is a safe place for my child to learn and have fun.
The hours of the Program meet my needs.
The Program staff maintains open communication with me.  They provide me with adequate information about my child and program activities.
The Program rules and policies have been clearly communicated to me.
I feel welcome to visit the Program and my child's classroom.
My child has access to quality materials and curriculum related resources in the Program.
My Child's Program AC Teacher usually provides extra help when needed.
There is adequate supervision provided in the Program.
The Program has helped my child do better in school.
I am satisfied with the instruction and activities provided to my child during the Program.
My child's AC Teacher has good classroom and behavior management skills.
The Site Coordinator (ACC) and AC Staff (Lead Teacher) maintain good discipline among the students during program activities.
My child usually enjoys the time he/she spends in the Program.
I would recommend the Program to other parents for their children.
The Site Coordinator (ACC) recognizes me when I visit the Program and at activities or events.
I often help out or volunteer in the Program.

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* 4. Please add any comments you have in response to the following questions:

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* 5. What three (3) things do you like about the Program?

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* 6. What three (3) things need improvement?

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