Lejeune-New River School Age Care Child Youth Programs Survey

OMB CONTROL NUMBER: 0704-0553

OMB EXPIRATION DATE: 05/31/2025

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information, 0704-0553, is estimated to average five minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

Dear Parents,

As we begin our re-accreditation process, we would like you to become part of this exciting journey. Quality improvement involves reflecting on our practice, developing improvement plans, taking action toward our goals, and making adaptations.

Please circle your responses based on your experience with the After School Program.

Top of Form

1.  Circle the child's grade:

K 1 2 3 4 5

2.  Your Role:

Parent Guardian

 3.  Circle the school your child attends:

TT Elementary Heroes Elementary DeLalio Elementary

Bottom of Form

4.  My child looks forward to the after school program:

Strongly Disagree	Disagree	No Opinion	Agree Strongly Agree

5.  I am pleased with the after school program:

Strongly Disagree	Disagree	No Opinion	Agree Strongly Agree

6. I feel my child is safe in the after school program:

Strongly Disagree	Disagree	No Opinion	Agree	Strongly Agree

7. I am pleased with the academic activities in the after school program:

Strongly Disagree	Disagree	No Opinion	Agree Strongly Agree	Strongly Agree

8. My child's academic performance has improved since joining the after-school program:

Strongly Disagree	Disagree	No Opinion	Agree Strongly Agree	Strongly Agree

9. I am pleased with the Positive Youth Development activities (i.e. cooking, arts and crafts, music, dance, etc.):

Strongly Disagree	Disagree	No Opinion	Agree	Strongly Agree

10. I am pleased with the Health and Wellness activities (i.e. sports, gym time, field trips, etc.):

Strongly Disagree	Disagree	No Opinion	Agree	Strongly Agree

11. I would recommend this after school program to other families:

Strongly Disagree	Disagree No Opinion	No Opinion Agree		St Strongly Agree

12. Did the program staff treat you well?

Yes

No

13. Did the program help your student?

Yes

No

14. What do you like most about the after school program? Please do not include personally identifiable information (PII) in your response.

15. What do you like least about the after school program? Please do not include PII in your response.

16. How can we make the after school program better? Please do not include PII in your response.

Thank you for your participation. We value your input and will share the changes we are making as a result of your feedback.