Our vision is that every child involved in the child welfare or juvenile justice systems becomes resilient, safe, healthy, and economically secure.

Youth Questionnaire (Age 10 – 13)

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.

Your First Name: Required

Your Last Name: Required

Your Email Address:

City: Required

State: Required

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 the child(ren) receiving appropriate services?

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

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:

Total file size for all files cannot exceed 17MB.

File Upload (pdf, xls, xlsx, doc, docx, jpg, png, gif, tiff, txt)

By the return of this document online, you attest that the information is true and accurate.

Please call the System Oversight Specialist on this case at the phone number listed in the letter you received. Otherwise call our main office at 402-471-4420 for assistance.

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"The soul is healed by being with children." Fyodor Dostoevsky

"There is no trust more sacred than the one the world holds with children." Kofi A. Annan

"Seek the wisdom of the ages, but look at the world through the eyes of a child." Ron Wild

"Children have more need of models than of critics." Carolyn Coats