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21st Century Community Learning Centers
Survey of Needs – Parents and Students

21st CCLC is a FREE afterschool and summer program that we are requesting for your child’s school. The program will be funded for FOUR years if awarded, which will be great for the school and community (and hundreds of students). The state requires us to better understand needs of parents and students when requesting the funding. Please provide your feedback on the questions below. Your answers are completely anonymous, so nobody can connect your answers to you or your children.
PARENT SURVEY
1.What school does your child(ren) attend (please complete a survey for each school serving your children)?
2.Does your child(ren) need afterschool and/or summer programming (check if YES)?
3.Would your child(ren) attend if these services were FREE (check if YES)?
4.Could you afford to pay for these services (they will be FREE if we get the grant)?
Yes
No
Afterschool ($125/Month)
Summer ($125/week)
5.Are afterschool and summer programs easily found in your community?
6.During the school year, we are planning on operating five days per week for 3.5 hours per day (immediately afterschool). What does your child NEED for afterschool hours and days?
7.For Summer, we are planning on operating five days per week for 12 hours per day (6:30am-6:30pm). What does your child NEED for summer hours and days?
STUDENT SURVEY
Please ask your child(ren) and tell us what they think below.
8.My children state they would like the following afterschool and summer (check all that apply):
9.My children state they want to attend the program every day:
10.My children state they have the hardest time with:
Thank you for your help in completing this survey.
Please send this survey to other parents from the schools listed.