ALL Program Participant Survey

Your Name* This field is required.

First Name

Last Name

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)

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

If you were to name our outdoor space- what special name would you give it?

River City is...* This field is required.

I come to R CITY because...* This field is required.

I think I am getting better at:

Calming Down

Listening to others

Using “I Statements"

Showing empathy for others

Knowing when to walk away in a conflict

Thinking about problems from someone else’s perspective

Apologizing or asking for forgiveness

Taking responsibility

Asking for Help

Naming my feelings

Standing up for myself in a respectful way

Compromising to solve a conflict

None of these

Other

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?

YESNO

My mentor is:* This field is required.

My mentor...* This field is required.

What is one thing that you and your mentor have talked about recently?* This field is required.

Because of my R CITY, I have...

What activities would you like to see R CITY do?* This field is required.

Any other comments or thoughts you would like us to know?

ALL Program Participant Survey