Request edit access
Needs Assessment Survey

Dear Students, Parents, Staff and Other Community Stakeholders,

Our school district is applying for a 21st Century Community Learning Center Grant opportunity.  The program will be held during non-school hours possibly including before-, after-, and summer- school depending on the input that we get from you on what you want to see in your school's program and the grant requirements.  Our district needs your input. It is very important that you complete this form no later than Friday, January 24th.

Sign in to Google to save your progress. Learn more
Name (optional)
I am: *
I would be willing to serve on the 21CCLC Advisory Committee to help my school ensure the program is effective and successful: (Be sure if you select yes, that you have entered your name in the first question.)
 *
Rate the following accordingly: *
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I am excited about the possibility of an after school program.
Programs during non-school hours will benefit our school.
Someone in my family would use the program.
There is a need for after school tutoring.
There is a need for a safe place for students to go after school to learn.
There is a need for students to have access to technology during non- school hours.
Select which academic items you would most like to see as part of an afterschool Program: *
Required
Select which enrichment opportunities you would like to see most as a part of an afterschool program:
Select which family service opportunities you would like to see most as a part of an afterschool program:
Select which college/workforce readiness opportunities you would like to see most as a part of an afterschool program:
Which non-school hours would be the most beneficial to you for program time?
Clear selection
What grades do you think would benefit the most from the program?
Clear selection
Would you be able to provide transportation for a student who attended the program?
Clear selection
Thank you for taking the time to help our district with this survey!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wonderview School District.

Does this form look suspicious? Report

Google Forms