This survey asks what you think of this after-school program. This is NOT a test. This survey is private. Please say what you really think!

Before you answer the survey, you must enter your Student ID number. If you need help, please ask an after-school program staff member.

* 1. What is your Student ID number?

* 2. What is your school?

* 3. What grade are you in? If you are in grades K-3, please stop and let the instructor know.

* 4. I am a . . . .