Parents: 21st CCLC Program Evaluation Survey

The purpose of this survey is to collect information from parents about the quality and effectiveness of our 21st Century Community Learning Center Program. Your feedback is critical to telling us how we did this year. Your information will also help us plan for next year. Please take 5 minutes to rate how strongly you agree or disagree with each statement.

Please return the form to your child's teacher if you are responding using a printed form.

Thank you for your time and effort responding to this survey.

	Strongly Disagree	Disagree	Agree	Strongly Agree
Reading / Language Arts	Reading / Language Arts Strongly Disagree	Reading / Language Arts Disagree	Reading / Language Arts Agree	Reading / Language Arts Strongly Agree
Mathematics	Mathematics Strongly Disagree	Mathematics Disagree	Mathematics Agree	Mathematics Strongly Agree
Science and Technology (for example, learning to code)	Science and Technology (for example, learning to code) Strongly Disagree	Science and Technology (for example, learning to code) Disagree	Science and Technology (for example, learning to code) Agree	Science and Technology (for example, learning to code) Strongly Agree
Problem-solving	Problem-solving Strongly Disagree	Problem-solving Disagree	Problem-solving Agree	Problem-solving Strongly Agree
Art / Theatre	Art / Theatre Strongly Disagree	Art / Theatre Disagree	Art / Theatre Agree	Art / Theatre Strongly Agree
Physical Fitness	Physical Fitness Strongly Disagree	Physical Fitness Disagree	Physical Fitness Agree	Physical Fitness Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

Reading / Language Arts

Reading / Language Arts Strongly Disagree

Reading / Language Arts Disagree

Reading / Language Arts Agree

Reading / Language Arts Strongly Agree

Mathematics

Mathematics Strongly Disagree

Mathematics Disagree

Mathematics Agree

Mathematics Strongly Agree

Science and Technology (for example, learning to code)

Science and Technology (for example, learning to code) Strongly Disagree

Science and Technology (for example, learning to code) Disagree

Science and Technology (for example, learning to code) Agree

Science and Technology (for example, learning to code) Strongly Agree

Problem-solving

Problem-solving Strongly Disagree

Problem-solving Disagree

Problem-solving Agree

Problem-solving Strongly Agree

Art / Theatre

Art / Theatre Strongly Disagree

Art / Theatre Disagree

Art / Theatre Agree

Art / Theatre Strongly Agree

Physical Fitness

Physical Fitness Strongly Disagree

Physical Fitness Disagree

Physical Fitness Agree

Physical Fitness Strongly Agree

	Strongly Disagree	Disagree	Disagree	Strongly Agree
The 21st CCLC program helped to improve my child's reading and writing skills.	The 21st CCLC program helped to improve my child's reading and writing skills. Strongly Disagree	The 21st CCLC program helped to improve my child's reading and writing skills. Disagree	The 21st CCLC program helped to improve my child's reading and writing skills. Disagree	The 21st CCLC program helped to improve my child's reading and writing skills. Strongly Agree
The 21st CCLC program helped to improve my child's math skills.	The 21st CCLC program helped to improve my child's math skills. Strongly Disagree	The 21st CCLC program helped to improve my child's math skills. Disagree	The 21st CCLC program helped to improve my child's math skills. Disagree	The 21st CCLC program helped to improve my child's math skills. Strongly Agree
I had opporutnities to become involved in my child's education and classroom activities.	I had opporutnities to become involved in my child's education and classroom activities. Strongly Disagree	I had opporutnities to become involved in my child's education and classroom activities. Disagree	I had opporutnities to become involved in my child's education and classroom activities. Disagree	I had opporutnities to become involved in my child's education and classroom activities. Strongly Agree
The Parent / Teacher conference(s) this year were helpful to me.	The Parent / Teacher conference(s) this year were helpful to me. Strongly Disagree	The Parent / Teacher conference(s) this year were helpful to me. Disagree	The Parent / Teacher conference(s) this year were helpful to me. Disagree	The Parent / Teacher conference(s) this year were helpful to me. Strongly Agree
The school provided me with an adequate amount of information about my child's learning strengths and weaknesses.	The school provided me with an adequate amount of information about my child's learning strengths and weaknesses. Strongly Disagree	The school provided me with an adequate amount of information about my child's learning strengths and weaknesses. Disagree	The school provided me with an adequate amount of information about my child's learning strengths and weaknesses. Disagree	The school provided me with an adequate amount of information about my child's learning strengths and weaknesses. Strongly Agree

Strongly Disagree

Disagree

Strongly Agree

The 21st CCLC program helped to improve my child's reading and writing skills.

The 21st CCLC program helped to improve my child's reading and writing skills. Strongly Disagree

The 21st CCLC program helped to improve my child's reading and writing skills. Disagree

The 21st CCLC program helped to improve my child's reading and writing skills. Strongly Agree

The 21st CCLC program helped to improve my child's math skills.

The 21st CCLC program helped to improve my child's math skills. Strongly Disagree

The 21st CCLC program helped to improve my child's math skills. Disagree

The 21st CCLC program helped to improve my child's math skills. Strongly Agree

I had opporutnities to become involved in my child's education and classroom activities.

I had opporutnities to become involved in my child's education and classroom activities. Strongly Disagree

I had opporutnities to become involved in my child's education and classroom activities. Disagree

I had opporutnities to become involved in my child's education and classroom activities. Strongly Agree

The Parent / Teacher conference(s) this year were helpful to me.

The Parent / Teacher conference(s) this year were helpful to me. Strongly Disagree

The Parent / Teacher conference(s) this year were helpful to me. Disagree

The Parent / Teacher conference(s) this year were helpful to me. Strongly Agree

The school provided me with an adequate amount of information about my child's learning strengths and weaknesses.

The school provided me with an adequate amount of information about my child's learning strengths and weaknesses. Strongly Disagree

The school provided me with an adequate amount of information about my child's learning strengths and weaknesses. Disagree

The school provided me with an adequate amount of information about my child's learning strengths and weaknesses. Strongly Agree

	Yes	No
Do you feel there is a need for before and after school programs like the one your child attended?	Do you feel there is a need for before and after school programs like the one your child attended? Yes	Do you feel there is a need for before and after school programs like the one your child attended? No
Do you have a computer at home?	Do you have a computer at home? Yes	Do you have a computer at home? No
Would you like your child or children to participate in a free after school program during the school year?	Would you like your child or children to participate in a free after school program during the school year? Yes	Would you like your child or children to participate in a free after school program during the school year? No
Would your participate in parent education sessions that promote drug-free living?	Would your participate in parent education sessions that promote drug-free living? Yes	Would your participate in parent education sessions that promote drug-free living? No
Would you participate in an educational session designed to help you improve your skills at helping your child?	Would you participate in an educational session designed to help you improve your skills at helping your child? Yes	Would you participate in an educational session designed to help you improve your skills at helping your child? No

Yes

Do you feel there is a need for before and after school programs like the one your child attended?

Do you feel there is a need for before and after school programs like the one your child attended? Yes

Do you feel there is a need for before and after school programs like the one your child attended? No

Do you have a computer at home?

Do you have a computer at home? Yes

Do you have a computer at home? No

Would you like your child or children to participate in a free after school program during the school year?

Would you like your child or children to participate in a free after school program during the school year? Yes

Would you like your child or children to participate in a free after school program during the school year? No

Would your participate in parent education sessions that promote drug-free living?

Would your participate in parent education sessions that promote drug-free living? Yes

Would your participate in parent education sessions that promote drug-free living? No

Would you participate in an educational session designed to help you improve your skills at helping your child?

Would you participate in an educational session designed to help you improve your skills at helping your child? Yes

Would you participate in an educational session designed to help you improve your skills at helping your child? No

Parents: 21st CCLC Program Evaluation

Purpose of Survey

Question Title

* 1. Please select the location where your child or children attended their 21st Century Community Learning Center's before school, after school or during school program.

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* 2. Please check the grade level your child (or children) was in this year. Please check one grade level for each child.

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* 3. Please check how strongly you agree or disagree with each statement as an area of high need for your child that staff should address in 21st CCLC program

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* 4. Please check the grade levels you think 21st CCLC should serve.

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* 5. Please tell us how strongly you agree or disagree with each statement.

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* 6. Please list any changes you want the school implement next year during the 21st CCLS

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* 7. Please answer each question by selecting "Yes" or "No".

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* 8. Please list activities that you would attend to help you improve your child's or children's learning and behavior in school.