Extracurricular Activities Impact Assessment Form
Help us understand how extracurricular activities influence your skills, well-being, and academic life.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Age
*
Select your current education level
*
Please Select
Elementary School
Middle School
High School
Undergraduate
Graduate
Other
Name of the Extracurricular Activity
*
What is your role in this activity?
*
Participant
Leader/Organizer
Volunteer
Other
How often do you participate in this activity?
*
Daily
Several times a week
Once a week
A few times a month
Rarely
Please rate the impact of this activity on the following areas:
*
Rows
No Impact
Slight Impact
Moderate Impact
Strong Impact
Very Strong Impact
Academic performance
1
2
3
4
5
Leadership skills
6
7
8
9
10
Teamwork
11
12
13
14
15
Self-confidence
16
17
18
19
20
Time management
21
22
23
24
25
Overall, how satisfied are you with your experience in this activity?
*
1
2
3
4
5
Has your participation in this activity influenced your future goals or aspirations?
*
Yes
No
Not sure
Please share any additional comments or examples about how this activity has impacted you.
Submit Assessment
Should be Empty: