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Questionnaires
Youth Questionnaire (Age 10 – 13)
"
*
" indicates required fields
User Information
Thank you for taking the time and answering our questions about how you are doing and the care you are receiving. What is reported in this questionnaire may be included in the local board’s report to the legal parties to the case. Your input will provide your personal view and is important for us to hear.
Name of Youth
*
First
Last
Email
Address
*
City
State / Province / Region
Board #: If Known
Meeting Date: If Known
Tell us how you are doing
What do you like to do with your friends when you spend time with them?
What activities are you involved in?
Are there activities that you would like to be involved in?
Placement
Do you feel safe where you live?
What do you like or dislike about where you live?
Is there somewhere else you would rather be living?
Education
How is school going?
What would help you with school or make your time at school better?
Visitation
Do you get to see your parents/guardians enough?
Do you get to see your brothers/sisters enough?
Do you get to see your brothers/sisters without your mom or dad there?
Is there anyone that you want to see that you currently are not able to?
Contacts from people on your court case
Your guardian ad litem is an attorney that represents your best interest. Does your guardian ad litem ask you what you would like to see happen?
You have a right to be at your court hearings. Do you attend these court hearings?
Yes
No
If YES – How was attending court?
Additional Information
Is there anything else you would like us to know that would improve your life?
Although not required, if you would like to submit any additional related documents you may do so below:
Accepted file types: pdf, xls, xlsx, doc, docx, jpg, png, gif, tiff, txt, Max. file size: 64 MB.
By returning this document, you confirm that the information is true and accurate and that you understand this information may be shared with the legal parties to the case.
