Fall Student Questionnaire

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* 1. Students Name

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* 2. School

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* 3. How often do you usually attend the afterschool Program?

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* 4. What grade are you in?

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* 5. How much do you agree with the following statements about the 21st Century afterschool program?

  Strongly Disagree Disagree In the Middle Agree Strongly Agree
I feel welcome in the program
The rooms used are safe and clean
The rules are clear and fair
Staff treat me with respect
Staff listen to what I have to say
It is easy to make friends in the program
I have a say in what we do in the program
Afterschool is fun
I have good attendance in the program
I have enough time to get my homework done in the program
They program helps me apply what I learn in school
I am happy with the program
I get better grades in school because of the program
I don't miss school because I want to go to the program
The program has helped me make friends
I am more prepared for school because of the program

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* 6. What do you like most about the afterschool program?

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* 7. How can we make the afterschool program better?

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