Homework Zone Program Pack Use That Book! Webinar

First Name: *

Last Name: *

Title: *

Company: *

Email: *

Address: *

Address Line 2:

City: *

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Zip: *

Phone # : *

Your primary role in afterschool programs: Select Afterschool frontline staff/teacher Afterschool program director or supervisor Resource and referral staff Consultant, trainer, advisor School administrator District administrator State administrator Other NO role in afterschool programs *

How long have you been in the afterschool field?
years *
months *

How many students typically attend your program each day? *

How many paid staff work in your afterschool program? *

What grades does your program serve? [Check all that apply]*
Pre-K Elementary Middle School High School

Program Setting(s)? [Check all that apply]*
rural small town suburban urban

Why did you choose to attend this session today?

Do you own or have access to Homework Zone Program Pack
Select Yes No Don't Know *

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