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* 1. Community Organization or Individual Family?

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* 2. If Community Organization please enter the name of the organization here:

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* 3. Caregiver Name:

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* 4. Relationship to Student:

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* 5. Reader and Leader Names:

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* 6. What influenced your decision to sign up for the program?

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* 7. How is the elementary school Reader currently receiving classroom instruction?

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* 8. Reader Questions:

  Stongly Agree Agree Neither Agree or Disagree Disagree Strongly Disagree
The Reader enjoys reading more than they did before participating in the RBBB at Home program
The Reader spends more time reading than they did before participating in the RBBB at Home program
The Reader now volunteers to read over other extracurricular activities like watching TV, playing video games, etc.
The Reader understands what they are reading more than they did before participating in the RBBB at Home program
The Reader can focus on reading materials from beginning to end more than they could before participating in the RBBB at Home program
The Reader has more confidence now in their reading ability than before participating in the RBBB at Home program

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* 9. How is the middle school Leader currently receiving classroom instruction?

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* 10. Leader Questions:

  Stongly Agree Agree Neither Agree or Disagree Disagree Strongly Disagree
The Leader displays stonger leadership skills than before participating in the RBBB at Home program
The Leader takes more opportunities to volunteer and help others than the did before participating in the RBBB at Home program
The Leader has more positive relationships with younger family members than they did before participating in the RBBB at Home program
The Leader seems to enjoy learning more than they did before participating in the RBBB at Home program
The Leader is more involved in their learning than they were before participating in the RBBB at Home program (this could be when they are participating in classroom activitites online or in person or when they are doing their homework)
The Leader is meeting or exceeding academic expectations

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* 11. Family Questions:

  Stongly Agree Agree Neither Agree or Disagree Disagree Strongly Disagree N/A
My family spends more time reading together than they did before participating in the RBBB at home program
My family feels more confident in how to support each other's reading skills (like asking thought provoking questions, or finding ways to encourage reading)
My family feels close when we read toghether

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* 12. If you previously did not sign up for the RBBB Newsletter would you be interested in receiving the monthly newsletter by email moving forward?

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* 13. Would you like to receive information about any future volunteer or engagement opportunities for your student(s) at RBBB?

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* 14. Email address you would like to be contacted at:

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