21st Century Community LC:  Parent Survey
Please complete the following questions based on your experience with the 21st Century Program and your observation of your child during his/her participation this year.  Please complete the survey in its entirety. Thank you for completing our parent survey! We will use this information to evaluate our program and improve it for the future.
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Email *
Child(dren's names):  Optional
My child(dren) is/are in: (check all that apply) *
Required
My child attends:  Check all that apply.   *
Required
Please indicate your level of agreement with the following statement:  The program addressed my child's specific needs. *
Please indicate your level of agreement with the following statement:  I had opportunities to visit the program. *
Please indicate your level of agreement with the following statement:  The program offered my child a variety of academic and enrichment activities. *
Based on your obersvation of your child, please select the answer that best describes how s/he has changed this year related to each of the following academic items: *
Did not need to improve
Improved
No Change
Declined
Reading
Math
Science
Social Studies
Use of technology
Homework completion
Based on your observation of your child, please select the answer that best describes how s/he has changed this year related to each of the following behavior items. *
Did not need to Improve
Improved
No change
Declined
Self Confidence
Attitude toward school/learning
Attendance at school
Behavior at School
Please rate your satisfaction with each of these program areas by checking one box for each row. *
Very Satisfied
Somewhat Satisfied
Unsatisfied
Overall Program
Communication
Academics
Recreation
The parent activities the program offered (i.e. parent workshops, Hooked on Science Night, etc.) met my needs. *
Required
In your opinion, what has been the most positive result of your child's participation in the 21st Century program this year?
In what ways, if any, do you think the program could improve?
Feel free to share additional comments
A copy of your responses will be emailed to the address you provided.
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