HomeMy WebLinkAboutExhibit 11D) The Children's Trust Child Satisfaction Survey
We want to know what you think about this program. Please tell us what you think about each statement
listed below. Also, tell us a little bit about yourself by filling out the top part of the survey.
I am years old. I am a a Boy o Girl.
What is your race? o Black Cl White ❑ Asian ❑ Other
What i5 your ethnicity? ra Hispanic a Haitian a Other
1. Adults here are fair.
2. The adults here make the program exciting.
3. If I have a problem, an adult here will help me.
4. I feel safe here.
5. There are enough things here for everyone to use.
6. I get along with the kids here.
7. I like coming here.
8. This program will help me do better in school.
9. I would tell my friends to come here.
10, What do you like best about the program?
11. What do you wish you could change about the program?
(Source: www.smiling-faces.com)
For Staff Use Only (MUST BE COMPLETED)
Please use this survey for children in elementary school.
Circle the face that describes
your thoughts about the statements.
47 41j
Definitely not
Definitely not
Definitely not
Definitely not
Definitely not
Definitely not
Definitely not
Definitely not
Definitely not
Not much Usually
Not much Usually
Not much Usually
Not much Usually
Not much Usually
Not much Usually
Not much Usually
Not much Usually
J Not much Usually
ORGANIZATION:
SITE LOCATION:
DATE CONDUCTED: HOW CONDUCTED?: 0 Self ❑ Read -Items a In -person
Definitely
Definitely
Definitely
Definitely
Definitely
Definitely
Definitely
Definitely
Definitely
The Children's Trust Youth Satisfaction Survey
We are interested in your thoughts about how this program is doing. Please tell us how much you agree
or disagree with each statement listed below. Also, please complete the top portion of the survey to tell
us a little bit about yourself.
I am years old. I am a o Boy o Girt.
Race: o Black o White a Asian a Other
Ethnicity: o Hispanic ❑ Haitian ❑ Other
1. Adults here are fair.
2. The adults here make the program exciting.
3. If I have a problem, an adult here will help me.
4. I feel safe here.
5. There are enough things here for everyone to use.
6. I get along with the students here.
7, I enjoy coming here.
8. This program will help me do better in school.
9. I would tell my friends to come here,
10. What do you like best about the program?
11. What do I wish I could change about the program is?
Circle the word(s) that best
describes your response.
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
12. What would you be doing if you didn't attend this out -of -school program?
o Watching TV o Doing Homework/Studying o Doing Nothing
o Playing ❑ Hanging Out o Other
Disagree
Disagree
Disagree
Disagree
Disagree
Disagree
Disagree
Disagree
Disagree
Agree
Agree
Agree
Agree
Agree
Agree
Agree
Agree
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
For Staff Use Only (MUST BE COMPLETED)
Please use this survey for children in middle and high school.
ORGANIZATION:
SITE LOCATION:
DATE CONDUCTED: HOW CONDUCTED?: a Self ❑ Read -Items ID In -person
The Children's Trust Parent Satisfaction Survey
We are interested in your thoughts about how this program is doing. Please tell us how
much you agree or disagree with each statement listed below. Also, please complete the
top portion of the survey to tell us a little bit about you and your family.
I am: o MALE o FEMALE RACE: o Black o White ❑ Asian ❑ Other
ETHNICITY: ❑ Hispanic o Haitian ❑ Other
HOW MANY OF YOUR CHILDREN ATTEND THIS PROGRAM?
AGE(S) OF CHILD(REN)
1. The staff treat my child fairly.
2. The staff get children excited about program
activities.
3. The staff respond to my child's own culture,
language, or special needs.
4. The staff keep me informed about program activities.
5. The staff keep me informed about my child's
progress.
6, I feel welcome by program staff.
7. The staff give me a chance to share my ideas.
8. My child is safe while attending the program.
9. This program will help my child do better in school.
10. My child likes coming to the program.
11. I would recommend this program to others.
12. What do you like best about the program?
Circle the woml(s) that best
describes your response.
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
Strongly
Disagree
13. What do you wish you could change about the program?
Disagree
Disagree
Disagree
Disagree
Disagree
Disagree
Disagree
Disagree
Disagree
Disagree
Disagree
Ag ree
Ag ree
Agree
Agree
Agree
Agree
Ag ree
Agree
Agree
Agree
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
Strongly
Agree
For Staff Use Only (MUST BE COMPLETED)
ORGANIZATION:
SITE LOCATION:
DATE CONDUCTED:
HOW CONDUCTED?: o Self o Read Items o In -person
OUT -OF -SCHOOL PROGRAMS
RFP #2005-06
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