Y4Y Program Success Stories

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Y4Y Program Success Stories

Youth for Youth Customer Satisfaction Surveys

OMB: 1880-0542

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Program Success Stories

(Web-based)

Public Burden Statement:



According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 5 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is voluntary. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email [email protected] and reference the OMB Control Number 1880-0542.

Program Success Stories

(Web-based)


Have you been successful in implementing activities that relate to one of our courses in project-based learning, aligning to the school day, STEM, or aligning with partners? If so, we’d love to hear from you. Please complete the questionnaire below and we will be happy to follow up with you via email. Thank you!




Your Name ________________________

Organization: ______________________________________________

Your Email Address: ___________________________________________

Is this success story about a 21st CCLC Program?

    • Yes

    • No

Grade Levels Served

    • PreK-3

    • 3-5

    • Middle School

    • High School

    • College Transition

Type of Programming

    • Before School

    • Afterschool

    • Summer

    • Weekend

Program Location

    • Rural (At least 2.5 miles from nearest town and 10 miles from a city or urban area)

    • Town (10 or more miles from a city or urban area)

    • Suburb (Urbanized area just outside a city)

    • City (Urban area and city)




Program Success Stories

(Web-based)

(continued from previous page)


Which area would be best categorizing your success story? (Please select one)

    • Project-Based Learning

    • Aligning with the School Day

    • Strengthening Partnerships

    • STEM (Science, Technology, Engineering, Mathematics)


Optional-Please tell us the details of your success story (Limit: 500 words)



















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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorAlfred Vitale
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File Created2021-01-31

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