My child(ren) currently attend(s):

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* 1. My child(ren) currently attend(s):

My child(ren) currently participates in a youth program at (check all that apply):

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* 2. My child(ren) currently participates in a youth program at (check all that apply):

Number of adults in household:

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* 3. Number of adults in household:

Number of children under 18 in household:

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* 4. Number of children under 18 in household:

When does your child(ren) need out-of-school-time programming?

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* 5. When does your child(ren) need out-of-school-time programming?

What mode of transportation does your child(ren) primarily utilize to attend programming?

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* 6. What mode of transportation does your child(ren) primarily utilize to attend programming?

In your opinion, how important are the following program options for the youth in your neighborhood? (check one box for each option)

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* 7. In your opinion, how important are the following program options for the youth in your neighborhood? (check one box for each option)

  Very Important Somewhat Important Neutral Not Very Important Not Important at all
Academic tutoring: academic enrichment that includes individual attention for students struggling with reading, math, and science
Recreation & physical activity: programs such as sports, nature, yoga and other physical activities
Arts & Creativity: programs that include arts, crafts, theatre, dance and music
Future self: introduction to careers and financial readiness skills such as budgeting and saving
Personal well-being: programs focused on helping a child cope with the normal stresses of life and building strong relationships with others
Life skills: programs such as nutrition, swim lessons, bicycle repair, pet care, personal safety, civic involvement and mentoring
STEM: enrichment in areas such as computer coding, robotics, city-building, engineering, and environmental sciences
From the list above, please rank the MOST IMPORTANT to LEAST IMPORTANT needs that should be addressed in creating youth programs.  (Rank each item with 1 being most important and 7 the least important.)

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* 8. From the list above, please rank the MOST IMPORTANT to LEAST IMPORTANT needs that should be addressed in creating youth programs.  (Rank each item with 1 being most important and 7 the least important.)

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