4-H Afterschool Program
Tell us what you think!
Complete for each after school program, club or activity you attended
Program/Club/Activity Name:_____________________________ Date: _____________
About You: I am _____ years old
I am a (circle) boy or girl
Please circle one of the following for each sentence below:
YES! = Very True
yes = mostly true
no = mostly not true
NO! = Not at all True
I felt safe, welcome and comfortable
in this program!
YES!
yes
no
NO!
I felt listened to and respected
by the adults in this program!
YES!
yes
no
NO!
I learned something new and
important in this program!
YES!
yes
no
NO!
This program helped me feel better
about myself and what I can do!
YES!
yes
no
NO!
I helped others (kids or adults) and
I made a difference in some way!
YES!
yes
no
NO!
This program was great and
I would recommend it to others!
YES!
yes
no
NO!
What did you like most about this program, club or activity?
What would you change or add to this program, club or activity?
Anything else you’d like to tell us or suggest to us for the future?