Parent Satisfaction Survey
Afternoons R.O.C.K. in Indiana is an after school
drug prevention program for youth aged 10 – 14 years.
The State agency that provides funds for this program would
like to know your thoughts on the program. Please
feel free to talk with your child before answering any question.
Your responses are anonymous and confidential. Your
responses will only be used for program planning and promotional
purposes.
How do you, as the parent or guardian of the youth
who took part in the after school program, rate the following?
Please click the button that best describes your feelings
about the following statements:
1. In which county do you reside?
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Adams
Allen
Bartholomew
Benton
Blackford
Boone
Brown
Carroll
Cass
Clark
Clay
Clinton
Crawford
Daviess
De Kalb
Dearborn
Decatur
Delaware
Dubois
Elkhart
Fayette
Floyd
Fountain
Franklin
Fulton
Gibson
Grant
Greene
Hamilton
Hancock
Harrison
Hendricks
Henry
Howard
Huntington
Jackson
Jasper
Jay
Jefferson
Jennings
Johnson
Knox
Kosciusko
LaGrange
Lake
LaPorte
Lawrence
Madison
Marion
Marshall
Martin
Miami
Monroe
Montgomery
Morgan
Newton
Noble
Ohio
Orange
Owen
Parke
Perry
Pike
Porter
Posey
Pulaski
Putnam
Randolph
Ripley
Rush
Saint Joseph
Scott
Shelby
Spencer
Starke
Steuben
Sullivan
Switzerland
Tippecanoe
Tipton
Union
Vanderburgh
Vermillion
Vigo
Wabash
Warren
Warrick
Washington
Wayne
Wells
White
Whitley
2. How old was your child when s/he participated in Afternoons R.O.C.K.
in Indiana?
--
10
11
12
13
14
Questions
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
3.
The adult(s) leading the after school program were good role
models for the youth.
4.
Youth in the program were treated with respect
and courtesy by the adult leaders.
5.
Youth in the program were told the rules for the
behavior expected of them.
6.
The adult leaders were firm and fair in enforcing
the programs’ rules.
7.
The activities in the after school program were
interesting and fun.
8.
The activities in the after school program helped
my youth to understand why it is
important not to use drugs, alcohol or tobacco.
9.
The program and the daily activities seemed well
planned.
10.
I read, understood, and completed a permission
form to allow my youth to participate
in this after school program.
11.
Before my youth began this program, I knew that
he/she would be asked to take a survey
about alcohol, tobacco and drugs at the beginning and at the end
of the program.
12.
After school programs, such as this, can help
youth say “NO” to using alcohol, tobacco, and other drugs?
13.
Since taking part in this program, my youth has
learned how using drugs can cause problems for him/her.
14.
I would feel comfortable approaching the leaders
of this program to ask about any appropriate concerns regarding my youth.
15.
My family would be willing to pay a small fee to
have an after school program for my youth during the school year.
16.
I would recommend this program to other families
with youth.
17. As a parent, the thing(s) I liked best about this program were:
18. The things my child liked best about this program were:
19. Please feel free to tell us about other things we can do to make
this after school program better: