West After School Center
Parent Questionnaire, January, 2008

Thank you for participating in the West After School Center 21st Century Community Learning Center after school programs.  In order to continue to meet the needs of the families we serve, we would ask that you take a few minutes to answer the following questions to the best of your knowledge.

Please click the appropriate button.

You may add additional comments or suggestions at the bottom of the form (Each line is limited to 80 characters).

  1. Please Enter Today's Date in mm/dd/yyyy format

  2. My child is in:

    First Grade
    Second Grade
    Third Grade
    Fourth Grade
    Fifth Grade


  3. My child benefits from this program.

    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    I Don't Know (Does not apply)

  4. The tutoring has helped improve my child's reading skills

    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    I Don't Know (Does not apply)

  5. The tutoring has helped improve my child's math skills.

    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    I Don't Know (Does not apply)

  6. My child enjoys the program and looks forward to attending each day.

    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    I Don't Know (Does not apply)

  7. My child tries harder in school since attending the program.

    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    I Don't Know (Does not apply)

  8. My child is safe while attending the After School Program.

    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    I Don't Know (Does not apply)

  9. The After School Staff members care about my child and encourage him/her to do well in school and in the program.

    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    I Don't Know (Does not apply)

  10. The After School Staff communicates with me.

    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    I Don't Know (Does not apply)

  11. My child has improved in the ability to follow directions and complete school tasks.

    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    I Don't Know (Does not apply)

  12. My child's behavior has improved at School.

    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    I Don't Know (Does not apply)

  13. My child's behavior has improved at The Center.

    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    I Don't Know (Does not apply)

  14. Please enter your email address:


  15. Please enter any additional comments in the areas below. (Each line is limited to 80 characters)








  22. Name (optional). All information is confidential.