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Youth Survey - Reconnecting Youth
1. Office Use Only Page
17%
Staff must complete this cover page for each individual/group administration session.
1
. Staff Name
Ball, Ann
Bennett, Tammy
Boone, Earl
Cook, Mina
Dixon, Malcolm
DObson, Armenous
Elmore, John
Fowler, Terri
Gabriel, Daniella
Gerena-Diaz, Angie
Hairston, Vickie
Henry, Jacqueline
Hughes, Colleen
Lawson, Zachary
Link, Allyson
Motley, John
Nelligan, Janice
Perry, Angela
Price, Stephen
Propst, Regina
Roberson, Wanda
Smith, Catherine
Smith, Donald
Smith, Kyle
Smith, Lora
Southerland, LeShaun
Troxler, JaVaughn
Staff Name
2
. In what County did the program operate?
Chatham
Durham
Forsyth
Iredell
Orange
Person
Randolph
Stokes
Surry
Wilkes
Yadkin
In what County did the program operate?
3
. Funding Source
CenterPoint
Crossroads
Durham
OPC
OPC/Durham
Sandhills
Sandhills/CenterPoint
Surry SOS
Stokes SOS
WSPFC-IMC/Safe
Funding Source
4
. Type:
Type:
Pre
Post
5
. School Name
Forbush Middle School
N. Asheboro Middle (NAMS)
S. Asheboro Middle (SAMS)
Asheboro High (ASH)
Asheboro High / Alternative
YMCA in Asheboro
Asheboro City
Atkins High
Bolton Elementary
Bolton Randolph Elementary
Bottom Elementary
Chatham Middle
Chestnut Grove Middle
CIP
Cook Elementary
Courtney School
East Iredell Middle School
Eastern Randolph High School
Eastway Elementary
Elkin Elementary
Elkin Middle
Elkin High
Efland Cheeks Elementary
Ephesus Elementary
Forest Park Elementary
Frank Porter Graham Elementary
Gentry Middle
Griffith Academy
Horton Middle
Kestrel Heights Charter
Kennedy Learning Center
London Elementary
Lowes Grove Middle
Hanes Middle
MeadowBrook Alternative
Mount Airy Middle
Neal Middle
NB Mills Elementary
North Stokes High
North Forsyth High
Northeastern Randolph Middle
Person Co. Learning Center
Piney Grove Middle
Ramseur Elementary
Randolph Early College High
Sandy Ridge Elementary
South Stokes High
Southeastern Middle
Southwestern Randolf High
Southmont Elementary
Stanback Middle
Third Creek Elementary
West Stokes High
Sandy Ridge ES AS
Piney Grove MS AS
School A
School B
School C
School D
School E
School Name
6
. School Grade
School Grade
6
7
8
9
10
11
12
7
. Staff Comments:
Staff Comments:
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