2012 Louisiana Afterschool Provider Survey
Progress: 
 
1.

Please enter the information indicated below.

 

 

 

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

2.

What age group(s) do you serve? (check all that apply)

 

 
Infant/toddler
Preschool
Elementary (grades K-5)
Middle School (grades 6-8)
High School (grades 9-12)
Young Adult
Other  
3.

When does your school-age or afterschool program operate? (SELECT ALL THAT APPLY)

 

 

 

 
Only during the academic year
Only during summer months
Both
4.

Do you offer programming during school vacations (not summer)?

 

 
Yes
No
5.

Do you offer programs that have SET schedules?

 
Yes
No
6.

Do you offer programming that relies on FLEXIBLE schedules? For example, a mentoring program?

 
Yes
No
7.

What day or days of the week does your program operate? (SELECT ALL THAT APPLY)

 
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
8.

What time of day do you offer programs? (SELECT ALL THAT APPLY)

 
Before School Program
Afterschool Program
Weekend Program
School Break/School Holiday Program
Summer Program
9.

What are the hours of operation for your programs? (for example, 3:30 - 6:00 pm)

 

 
 

50 characters left.
10.

What kinds of programming/activities do you currently offer?

 

 

 

 
Homework help
Tutoring program
Reading (ELA) curriculum
Math curriculum
STEM (science math engineering technology) or Media
Leadership development/youth development/life skills
Youth voice and civic engagement
Counseling/therapy/ca-
se management
Dance/music/art/theat-
er
Mentoring
Project-based learning
Service learning in the community
Cultural competency
Physical activity/sports/recre-
ation
Youth employment opportunities
College/job application assistance
Work/College/Career Readiness Skills
Nutrition
Other  
11.

Who develops the program curriculum?  What curriculum or resources do you use to develop program activities? 

 
 

350 characters left.
12.

Do participants have a say in developing program activities or curriculum, particularly middle school or high school participants?

 
Yes
No
13.

Would you be interested in trainings on how to incorporate additional academic enrichment activities into your programs?

 
Yes
No