You can always press Enter⏎ to continue
Hello R CITY friend!
Please fill out and submit this form about programs at R CITY for $2 R CITY Bucks!
12
Questions
START
Language
English (US)
Spanish (Latin America)
1
Your Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
What programs do you attend at R CITY?
*
This field is required.
Select all that you attend
Dreambuilders
Peacebuilders
Hopebuilders Mentoring
Citybuilders Apprenticeships (Harambee, DB Apprentice, Print Shop)
Previous
Next
Submit
Press
Enter
3
What activities have you experienced at R CITY?
*
This field is required.
Select any that you have participated in.
After School
Summer Camp
Apprentice Job Training
SEL/Life Skills Class
Field Trip
Mentor Outing
Community Events
Other
Previous
Next
Submit
Press
Enter
4
If you were to name our outdoor space- what special name would you give it?
Previous
Next
Submit
Press
Enter
5
River City is...
*
This field is required.
FUN!
a place where everyone is respected.
a SAFE home for all.
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
FUN!
a place where everyone is respected.
a SAFE home for all.
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Previous
Next
Submit
Press
Enter
6
I come to R CITY because...
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
7
Do you think participating in programs at R CITY has helped to improve your life?
*
This field is required.
OR has helped you improve as a person?
YES
NO
Previous
Next
Submit
Press
Enter
8
My mentor is:
*
This field is required.
Please Select
Bryanna McKreith
Clifton Turner
Cristina Galvan
Hannah Oliver
Mizani Jones
Hanns Nacua
Kayla Ingram
Lance Harris
Michael Crump
Shawn Childs
Vanessa Clyde
Ms. Howard
More than one
I don't know
Please Select
Please Select
Bryanna McKreith
Clifton Turner
Cristina Galvan
Hannah Oliver
Mizani Jones
Hanns Nacua
Kayla Ingram
Lance Harris
Michael Crump
Shawn Childs
Vanessa Clyde
Ms. Howard
More than one
I don't know
Previous
Next
Submit
Press
Enter
9
My mentor...
*
This field is required.
is FUN!
is a good listener.
keeps me safe.
cares about me.
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
is FUN!
is a good listener.
keeps me safe.
cares about me.
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Previous
Next
Submit
Press
Enter
10
What is one thing that you and your mentor have talked about recently?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
11
What activities would you like to see R CITY do?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
12
Any other comments or thoughts you would like us to know?
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
Should be Empty:
ALL Program Participant Survey
[Edit]
Question Label
1
of
12
See All
Go Back
Submit