21st Century Community Learning Centers Student Survey 2106 The 21st CCLC program will end this June 30, 2016. Your responses to these questions will help us develop our needs assessment. Your ideas and feedback are important to us.

Question Title

* 1. What is the name of your school?

Camden Elementary School

East Flora Elementary School

Luther Branson Elementary School

Shirley D. Simmons Middle School

Question Title

* 2. What is your gender?

Male

Female

Question Title

* 3. What grade are you in this school year?

Kindergarten

1st

2nd

3rd

4th

5th

6th

7th

8th

Question Title

* 4. Have you attended a 21 Century program in past grades? For example, if you are in 7th grade this year, did you attend the after school program in 6th grade?

Yes

Question Title

* 5. How often do you attend 21st Century program activities?

5 days per week

3-4 days per week

1-2 days per week

Question Title

* 6. I will not be able to attend 21st Century programs because of the following reason/s.

Clubs or other activities such as church, scouting and volunteer work

Too much homework

My friends do not attend

I am not interested in attending

I did attend but did not like it

Other (please specify)

Question Title

* 7. I would attend the following activities if they were offered at the 21st Century after-school programs:

	Very interested in attending	Interested in attending	Somewhat interested in attending	Would not attend
Video Production/Film Production	Video Production/Film Production Very interested in attending	Video Production/Film Production Interested in attending	Video Production/Film Production Somewhat interested in attending	Video Production/Film Production Would not attend
Piano	Piano Very interested in attending	Piano Interested in attending	Piano Somewhat interested in attending	Piano Would not attend
Visual Arts	Visual Arts Very interested in attending	Visual Arts Interested in attending	Visual Arts Somewhat interested in attending	Visual Arts Would not attend
Dance	Dance Very interested in attending	Dance Interested in attending	Dance Somewhat interested in attending	Dance Would not attend
Vocal	Vocal Very interested in attending	Vocal Interested in attending	Vocal Somewhat interested in attending	Vocal Would not attend
Drama	Drama Very interested in attending	Drama Interested in attending	Drama Somewhat interested in attending	Drama Would not attend
Strings	Strings Very interested in attending	Strings Interested in attending	Strings Somewhat interested in attending	Strings Would not attend

Question Title

* 8. What other activities would you like to see offered in the 21st Century programs at your school?

Question Title

* 9. Did 21st Century program activities help you with your classroom studies in mathematics and reading?

Yes

Question Title

* 10. Did you enjoy 21st Century activties and extended learning (field trips)?

Yes

Question Title

* 11. What was the best field trip site for you this past school year?

Question Title

* 12. Did you enjoy the healthy snacks/foods that you received during 21st Century program hours.

Yes