PBC SURVEY 3
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1
. Do you set personal goals for yourself and write them down?
Do you set personal goals for yourself and write them down?
a. Yes
b. No
c. Sometimes
2
. Who do you live with?
Who do you live with?
a. Both parents
b. One parent
c. Grandparents
d. Other relative
e. Guardian/relative
f. Guardian/non-relative
g. Other _________
3
. Do you feel safe at home?
Do you feel safe at home?
a. Yes
b. No
c. Most of the time
d. Some of the time
4
. How old are you?
How old are you?
a. 13
b. 14
c. 15
d. 16
e. 17
f. 18
g. 19
5
. What grade are you in?
What grade are you in?
a. 9th
b. 10th
c. 11th
d. 12th
6
. Do you plan on going to college?
Do you plan on going to college?
a. Yes
b. No
c. Maybe
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