Participant Survey
Date:
School:
Grade:
Student ID#:
Did you attend an after-school program last year?
Yes
No
Part I. About Your School Day
2. Do you like going to school?
No, hardly ever
Sometimes
Most time
Yes, almost always
3. Do you study hard for tests?
No, hardly ever
Sometimes
Most time
Yes, almost always
4. Are your classes interesting?
No, hardly ever
Sometimes
Most time
Yes, almost always
5. Do you get in trouble at school?
No, hardly ever
Sometimes
Most time
Yes, almost always
6. Do your parents talk to you about school or homework?
No, hardly ever
Sometimes
Most time
Yes, almost always
7. Do you feel comfortable talking to teachers or other schools staff?
No, hardly ever
Sometimes
Most time
Yes, almost always
8. Do you get your homework done on time?
No, hardly ever
Sometimes
Most time
Yes, almost always
9. How do you feel about yourself?
Poor
Fair
Good
Excellent
10. How are your grades?
Poor
Fair
Good
Excellent
Part II. About your after-School Program.
1. Do you enjoy the after-school program?
No, hardly ever
Sometimes
Most time
Yes, almost always
2. How many days each week would you like to attend the after-school program?
Once a week
2 days a week
3 days a week
4 days a week
Every day
3. Do you feel safe in the after-school program?
No, hardly ever
Sometimes
Most time
Yes, almost always
4. Does after-school staff help you with your homework?
No, hardly ever
Sometimes
Most time
Yes, almost always
5. Do you have enough quiet time to complete homework at the after-school program?
No, hardly ever
Sometimes
Most time
Yes, almost always
6. Are you doing better in school since you started coming to the after-school program?
No, hardly ever
Sometimes
Most time
Yes, almost always
7. Do you feel happier or less stressed since attending the after-school program?
No, hardly ever
Sometimes
Most time
Yes, almost always
8. Would you like more time for activities, other homework, in the after-school program?
No, hardly ever
Sometimes
Most time
Yes, almost always
9. Do you have friends, or someone you like, in the after-school program?
No, hardly ever
Sometimes
Most time
Yes, almost always
10. Do you feel comfortable talking to the after-school staff?
No, hardly ever
Sometimes
Most time
Yes, almost always
11. Does the after-school staff take time to help you or talk with you when you need it?
No, hardly ever
Sometimes
Most time
Yes, almost always
12. Would you tell others to participate in the after-school program?
No, hardly ever
Sometimes
Most time
Yes, almost always
13. Why do you participate in the after-school program? (check all that apply)
I need after-school supervision
My friends are attending
There are interesting activities
My parent(s) thought it would be good for me
My teacher recommended it
To get my homework done
Other, explain below
14. What would you be doing after school if you weren't coming to the after-school program?
15. What is your favorite part of the after-school program?
16. Do you have any ideas to make the after-school program better?
Northwest Regional Educational Laboratory
101 SW Main Street, Suite 500
Portland, Oregon 79212