Purpose of 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.

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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* 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.

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

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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* 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

  Strongly Disagree Disagree Agree Strongly Agree
Reading / Language Arts
Mathematics
Science and Technology (for example, learning to code)
Problem-solving
Art / Theatre
Physical Fitness
Please check the grade levels you think 21st CCLC should serve.

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

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

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

  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 math skills.
I had opporutnities to become involved in my child's education and classroom activities.
The Parent / Teacher conference(s) this year were helpful to me.
The school provided me with an adequate amount of information about my child's learning strengths and weaknesses.
Please list any changes you want the school implement next year during the 21st CCLS

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

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

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

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

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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.

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