After School Needs Survey
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 Would you use After School programming if they were available to you? *
 Please mark the type of After School care you are currently utilizing. *
Required
Would your child participate in tutoring if offered in after school program? *
Would you attend adult classes if offered after school? *
Required
 If you do not utilize After School Program , what prevents you from using the service? *
Required
 To help assess funding needs, please indicate your household gross salary range. *
What is the number of people in your household? *
 Please check the days you need child care. Check all that apply. *
Required
Please check the times you need school-age childcare. Check all that apply. *
Required
What time would you be interested in dropping off for Before School programming? *
 Have you had any of these child care related problems during the past year? Check all that apply. *
Required
Please leave your contact information (name and phone/email)  if you are interested in being involved with an After School Program as any of the following: volunteer, substitute, advisory committee, or other support.
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