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* 1. What afterschool site do you attend?

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* 2. What grade are you in?

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

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* 4. Think about the time you spent in the afterschool program this semester. How much do you agree with the following statements?

  1
Strongly Disagree 		2
Disagree 		3
In the Middle 		4
Agree 		5
Strongly Agree
1. I feel welcome in the program.
2. I am safe at the program.
3. I understand the rules.
4. The rules are applied fairly for all students.
5. Staff treat me with respect.
6. Staff listen when I want to share about my personal life or interests.
7. I have a say in what we do in the program.
8. Staff listen when I have suggestions or comments about the program.
9. Afterschool is fun most of the time.
10. I have enough time to get my homework done in the program.
11. The program helps me do better in school.
12. The program helps me apply what I learn in school.
13. I like the program most of the time.
14. I get better grades because I come to the program.
15. I don’t miss school because I want to go to the program.
16. I am more prepared for the school day because of what we do at the program.
17. I have more friends because of the program.
18. I get along better with my classmates because of the program.
19. I make better decisions because of the program.

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

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

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