This survey is designed to collect information about changes in a particular student's behavior during the school year. Please select only one response for each of the questions asked in the table below. Please note that survey response options are divided into two primary groups: (1) Did Not Need to Improve, which suggests that the student had already obtained an acceptable level of functioning and no improvement was needed during the course of the school year; and (2) Acceptable Level of Functioning Not Demonstrated Early in School Year-Improvement Warranted, which suggests that the student was not functioning as a desirable level of performance on the behavior being described. If the student warranted improvement on a given behavior, please indicate the extent to which the student did or did not improve on that behavior during the course of the school year by indicating the applicable change level. If you believe the behavior described in a given question is not applicable for the student for whom you are completing the survey (e.g. homework is not given in your classroom because of the age of the student), please do not provide a response for that question. Your responses to this survey are used to fulfill the 21st Century program’s required state and federal reports.  Your time to complete this task is appreciated.
Note: each student's survey must be entered individually.

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* 1. Name of Student (Last, First format preferred)

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* 2. Student's Grade

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* 3. District/Charter School Name

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* 4. School Building

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* 5. Subject Taught (if middle or high school):

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* 6. To what extent has your student changed their behavior in terms of completing homework to your satisfaction.

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* 7. To what extent has your student changed their behavior in terms of participating in class.

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* 8. To what extent has your student changed their behavior in terms of volunteering (e.g. for extra credit or more responsibilities).

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* 9. To what extent has your student changed their behavior in terms of being attentive in class.

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* 10. To what extent has your student changed their behavior in terms of behaving well in class.

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* 11. To what extent has your student changed their behavior in terms of academic performance.

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* 12. To what extent has your student changed their behavior in terms of coming to school motivated to learn.

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* 13. Grantee/21st CCLC Program Student Attends
Grantees are listed in alphabetical order.

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* 14. Teacher name.  Requested for more efficient matching and follow up purposes.

Please click the submit button below to submit your survey.  Once your survey has been accepted, you will be redirected back to AIU's 21st CCLC Teacher Survey page.  

If you are not re-directed back to AIU's webpage, your survey was not recorded.
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