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* 1. What grade level is your student? (Mark all that apply)

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* 2. How many days per week would you be likely to send your student(s) to a free After School Program?

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* 3. If an After School program was offered, what time would be a convenient end time?

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* 4. Rank these aspects of an After School Program from most to least important

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* 5. If you sent your student to an After School Program, how important would snack/nutrition services be?

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* 6. Please leave feedback about our current After School Program (Math Shack). How is it or isn't it meeting you and your student's needs?

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* 7. Please leave any additional comments.

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