Toolkit for Evaluating Positive Youth Development

[Questions a and b are required if choosing the Cultural Competency domain.]11) How much do you…A Very Don’tlot Some little None knowa) Think you know about people of other cultures, racesor ethnic groups? b) Know about your own culture, race or ethnic group? [Questions 12 and 13 are omitted on the pre-program survey, and OPTIONAL on the post-onlysurvey.][Demographic questions 14-20 are required.]14) How often do you come to [thisprogram]? Every day or almost everyday(4-5 times per week) Two to three times a week Once a week A couple times a month Less than once a month15) When did you start coming to [thisprogram]? Within the last 3 months 4 to 6 months ago 7 to 12 months ago More than 1 year ago16) How old are you? 6 years or younger 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years or older17) What grade are you in? _________18) Are you a girl/female or boy/male?Girl/FemaleBoy/Male19) Which best describes you? Caucasian/White African American/Black Asian/Pacific Islander Latino/Hispanic Native American Bi-racial/Multi-racial Other ______________[Must be customized for each ASI grantee.]20) Check each of the after-schoolactivities you participate in at [thisprogram]. __________________________ __________________________ __________________________ __________________________ __________________________Thank you for your answers!Toolkit for Evaluating Positive Youth Development 104