Pemberton Parent Survey

Question Title

* 1. What is the grade level of the student for whom you are completing this survey?

3rd grade

4th grade

5th grade

Other (please specify)

Question Title

* 2. What is your relationship to the child for whom you answered this survey?

Mother

Father

Step-parent

Grandparent

Aunt or Uncle

Brother or Sister

Other (please specify)

Question Title

* 3. Why did you enroll your child in this after-school program? How important were each of the following reasons?

	A Big Reason	A Small Reason	Not a Reason
My child wanted to enroll	My child wanted to enroll A Big Reason	My child wanted to enroll A Small Reason	My child wanted to enroll Not a Reason
I need childcare	I need childcare A Big Reason	I need childcare A Small Reason	I need childcare Not a Reason
I believe the program will help my child perform better in school	I believe the program will help my child perform better in school A Big Reason	I believe the program will help my child perform better in school A Small Reason	I believe the program will help my child perform better in school Not a Reason
I want my child to get help with homework	I want my child to get help with homework A Big Reason	I want my child to get help with homework A Small Reason	I want my child to get help with homework Not a Reason
I want my child to participate in new types of activities	I want my child to participate in new types of activities A Big Reason	I want my child to participate in new types of activities A Small Reason	I want my child to participate in new types of activities Not a Reason
I want my child to gain more confidence in himself/herself	I want my child to gain more confidence in himself/herself A Big Reason	I want my child to gain more confidence in himself/herself A Small Reason	I want my child to gain more confidence in himself/herself Not a Reason
I want my child to develop better personal/social skills (e.g., get along with other kids better, follow directions, listen to adults)	I want my child to develop better personal/social skills (e.g., get along with other kids better, follow directions, listen to adults) A Big Reason	I want my child to develop better personal/social skills (e.g., get along with other kids better, follow directions, listen to adults) A Small Reason	I want my child to develop better personal/social skills (e.g., get along with other kids better, follow directions, listen to adults) Not a Reason
The program provides a way for my child to be with friends	The program provides a way for my child to be with friends A Big Reason	The program provides a way for my child to be with friends A Small Reason	The program provides a way for my child to be with friends Not a Reason
I want my child to be safe after school	I want my child to be safe after school A Big Reason	I want my child to be safe after school A Small Reason	I want my child to be safe after school Not a Reason

Question Title

* 4. Select the type of student activity that is most important in this after school program. Please select just one.

Homework Help

Academic Enrichment (i.e. tutoring, literacy, math)

Arts (i.e. drama, music, art)

Sports or Physical Activities

Social Development

Question Title

* 5. Select the option(s) that best describe how the program staff supports the parents. You may choose more than one.

informs and communicates about program events

provides useful content during parent meetings or workshops

responds quickly when there are issues affecting the children

provides opportunities for the whole family to participate in the program

provides safe and supportive environment during after school hours

	Strongly Agree	Agree	Disagree	Strongly Disagree
My child is getting his or her homework completed on a daily basis	My child is getting his or her homework completed on a daily basis Strongly Agree	My child is getting his or her homework completed on a daily basis Agree	My child is getting his or her homework completed on a daily basis Disagree	My child is getting his or her homework completed on a daily basis Strongly Disagree
My child is getting the academic help that he or she needs	My child is getting the academic help that he or she needs Strongly Agree	My child is getting the academic help that he or she needs Agree	My child is getting the academic help that he or she needs Disagree	My child is getting the academic help that he or she needs Strongly Disagree
My child is doing better in language arts	My child is doing better in language arts Strongly Agree	My child is doing better in language arts Agree	My child is doing better in language arts Disagree	My child is doing better in language arts Strongly Disagree
My child is doing better in math	My child is doing better in math Strongly Agree	My child is doing better in math Agree	My child is doing better in math Disagree	My child is doing better in math Strongly Disagree
My child has eliminated or decreased the number of disciplinary referrals	My child has eliminated or decreased the number of disciplinary referrals Strongly Agree	My child has eliminated or decreased the number of disciplinary referrals Agree	My child has eliminated or decreased the number of disciplinary referrals Disagree	My child has eliminated or decreased the number of disciplinary referrals Strongly Disagree
My child is more confident	My child is more confident Strongly Agree	My child is more confident Agree	My child is more confident Disagree	My child is more confident Strongly Disagree
My child talks more about what he or she is doing in school	My child talks more about what he or she is doing in school Strongly Agree	My child talks more about what he or she is doing in school Agree	My child talks more about what he or she is doing in school Disagree	My child talks more about what he or she is doing in school Strongly Disagree
My child is safer during the out-of-school hours	My child is safer during the out-of-school hours Strongly Agree	My child is safer during the out-of-school hours Agree	My child is safer during the out-of-school hours Disagree	My child is safer during the out-of-school hours Strongly Disagree
My child understands more about how to use his or her strengths to build a career	My child understands more about how to use his or her strengths to build a career Strongly Agree	My child understands more about how to use his or her strengths to build a career Agree	My child understands more about how to use his or her strengths to build a career Disagree	My child understands more about how to use his or her strengths to build a career Strongly Disagree
The program overall is having a positive impact on my family	The program overall is having a positive impact on my family Strongly Agree	The program overall is having a positive impact on my family Agree	The program overall is having a positive impact on my family Disagree	The program overall is having a positive impact on my family Strongly Disagree
Our family is more involved with school activities because of this program.	Our family is more involved with school activities because of this program. Strongly Agree	Our family is more involved with school activities because of this program. Agree	Our family is more involved with school activities because of this program. Disagree	Our family is more involved with school activities because of this program. Strongly Disagree
I talk about happenings at school more with my child since we've been involved with the program.	I talk about happenings at school more with my child since we've been involved with the program. Strongly Agree	I talk about happenings at school more with my child since we've been involved with the program. Agree	I talk about happenings at school more with my child since we've been involved with the program. Disagree	I talk about happenings at school more with my child since we've been involved with the program. Strongly Disagree
Program staff members do a good job of communicating with me by way of emails, social networks, phone, or conversations at program events.	Program staff members do a good job of communicating with me by way of emails, social networks, phone, or conversations at program events. Strongly Agree	Program staff members do a good job of communicating with me by way of emails, social networks, phone, or conversations at program events. Agree	Program staff members do a good job of communicating with me by way of emails, social networks, phone, or conversations at program events. Disagree	Program staff members do a good job of communicating with me by way of emails, social networks, phone, or conversations at program events. Strongly Disagree

Strongly Agree

Agree

Disagree

Strongly Disagree

My child is getting his or her homework completed on a daily basis

My child is getting his or her homework completed on a daily basis Strongly Agree

My child is getting his or her homework completed on a daily basis Agree

My child is getting his or her homework completed on a daily basis Disagree

My child is getting his or her homework completed on a daily basis Strongly Disagree

My child is getting the academic help that he or she needs

My child is getting the academic help that he or she needs Strongly Agree

My child is getting the academic help that he or she needs Agree

My child is getting the academic help that he or she needs Disagree

My child is getting the academic help that he or she needs Strongly Disagree

My child is doing better in language arts

My child is doing better in language arts Strongly Agree

My child is doing better in language arts Agree

My child is doing better in language arts Disagree

My child is doing better in language arts Strongly Disagree

My child is doing better in math

My child is doing better in math Strongly Agree

My child is doing better in math Agree

My child is doing better in math Disagree

My child is doing better in math Strongly Disagree

My child has eliminated or decreased the number of disciplinary referrals

My child has eliminated or decreased the number of disciplinary referrals Strongly Agree

My child has eliminated or decreased the number of disciplinary referrals Agree

My child has eliminated or decreased the number of disciplinary referrals Disagree

My child has eliminated or decreased the number of disciplinary referrals Strongly Disagree

My child is more confident

My child is more confident Strongly Agree

My child is more confident Agree

My child is more confident Disagree

My child is more confident Strongly Disagree

My child talks more about what he or she is doing in school

My child talks more about what he or she is doing in school Strongly Agree

My child talks more about what he or she is doing in school Agree

My child talks more about what he or she is doing in school Disagree

My child talks more about what he or she is doing in school Strongly Disagree

My child is safer during the out-of-school hours

My child is safer during the out-of-school hours Strongly Agree

My child is safer during the out-of-school hours Agree

My child is safer during the out-of-school hours Disagree

My child is safer during the out-of-school hours Strongly Disagree

My child understands more about how to use his or her strengths to build a career

My child understands more about how to use his or her strengths to build a career Strongly Agree

My child understands more about how to use his or her strengths to build a career Agree

My child understands more about how to use his or her strengths to build a career Disagree

My child understands more about how to use his or her strengths to build a career Strongly Disagree

The program overall is having a positive impact on my family

The program overall is having a positive impact on my family Strongly Agree

The program overall is having a positive impact on my family Agree

The program overall is having a positive impact on my family Disagree

The program overall is having a positive impact on my family Strongly Disagree

Our family is more involved with school activities because of this program.

Our family is more involved with school activities because of this program. Strongly Agree

Our family is more involved with school activities because of this program. Agree

Our family is more involved with school activities because of this program. Disagree

Our family is more involved with school activities because of this program. Strongly Disagree

I talk about happenings at school more with my child since we've been involved with the program.

I talk about happenings at school more with my child since we've been involved with the program. Strongly Agree

I talk about happenings at school more with my child since we've been involved with the program. Agree

I talk about happenings at school more with my child since we've been involved with the program. Disagree

I talk about happenings at school more with my child since we've been involved with the program. Strongly Disagree

Program staff members do a good job of communicating with me by way of emails, social networks, phone, or conversations at program events.

Program staff members do a good job of communicating with me by way of emails, social networks, phone, or conversations at program events. Strongly Agree

Program staff members do a good job of communicating with me by way of emails, social networks, phone, or conversations at program events. Agree

Program staff members do a good job of communicating with me by way of emails, social networks, phone, or conversations at program events. Disagree

Program staff members do a good job of communicating with me by way of emails, social networks, phone, or conversations at program events. Strongly Disagree

Pemberton Parent Survey - Spring 2019

Question Title

* 1. What is the grade level of the student for whom you are completing this survey?

Question Title

* 2. What is your relationship to the child for whom you answered this survey?

Question Title

* 3. Why did you enroll your child in this after-school program? How important were each of the following reasons?

Question Title

* 4. Select the type of student activity that is most important in this after school program. Please select just one.

Question Title

* 5. Select the option(s) that best describe how the program staff supports the parents. You may choose more than one.

Question Title

* 6. Please respond as to how much you agree with the following statements.

As a result of participating in this after school program...

Question Title

* 1. What is the grade level of the student for whom you are completing this survey?

Question Title

* 2. What is your relationship to the child for whom you answered this survey?

Question Title

* 3. Why did you enroll your child in this after-school program? How important were each of the following reasons?

Question Title

* 4. Select the type of student activity that is most important in this after school program. Please select just one.

Question Title

* 5. Select the option(s) that best describe how the program staff supports the parents. You may choose more than one.

Question Title

* 6. Please respond as to how much you agree with the following statements.As a result of participating in this after school program...

* 6. Please respond as to how much you agree with the following statements.

As a result of participating in this after school program...