After-School Initiative's Toolkit for Evaluating

[ASI program staff may delete some or all of the questions below if they will not be asking questions related
to such topics]
• Being involved in this program has helped me to stay away from tobacco (Yes, Kind of, Not Really)
• Being involved in this program has helped me to stay away from drugs (Yes, Kind of, Not Really)
• Being involved in this program has helped me to stay away from alcohol (Yes, Kind of, Not Really)
• Being involved in this program has helped me to stay away from sex (Yes, Kind of, Not Really)
Your child’s participation in this evaluation is strictly voluntary. Your child is free to refuse participation.
Your child can skip (not answer) questions that he/she does not wish to answer. Participation in the
evaluation is not required nor does it affect program attendance in a positive or negative way. In addition, if
your child leaves or is absent (including voluntary withdrawal, temporary absence, suspension, expulsion or
termination) from [name of ASI program] he/she may still be asked to participate in the evaluation.
There may be some risk to your child from participating in this evaluation. Some of the questions we ask
may be embarrassing or make youth participants feel uncomfortable. For example, a child may not want to
respond to a question about their self-esteem or personal behaviors. As stated above, your child has the
right to skip (not answer) any of the questions that make him/her embarrassed or uncomfortable. This
program evaluation has been designed specifically for children and is not unlike questions that your child
might encounter in school or other such programs. However, if you are at all concerned, you are
encouraged to contact the after-school program staff to review the evaluation materials.
All information your child provides for evaluation will be used for statistical and evaluative purposes in such
a manner that [Choose either: (your child cannot be identified. Your child’s name will not appear anywhere
in reports generated by [name of ASI program/agency], NRC or The Colorado Trust. All information your
child provides for evaluation will be kept confidential.) (OR) (All information your child provides for
evaluation will be confidential.)] There are two exceptions to the promise of confidentiality: If information is
revealed concerning suicide, homicide or child abuse and neglect, law requires that such information be
reported to the proper authorities. In addition, should any information contained in this evaluation be the
subject of a court order or lawful subpoena, [name of ASI program/agency] might be compelled to disclose
information in compliance with the subpoena.
[If applicable] In addition, the evaluation team of [name of ASI program/agency] may wish to examine
program participants’ school records (report cards, CSAP scores, scores on standardized tests, attendance
Toolkit for Evaluating Positive Youth Development 43