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* 1. Do you feel safe where you live now?

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* 2. Are you included in activities and celebrations as much as you want?

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* 3. Is your case worker someone you can talk to?

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* 4. Is there food and drinks you like where you live now?

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* 5. Do you have the school supplies and other things you need?

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* 6. Do you get help with projects, tasks, or homework where you live?

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* 7. Can you have your own things at your placement?

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* 8. Does your case worker answer your questions?

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* 9. Do you know how to contact your case worker?

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* 10. I receive services and help from the agency when I need them?

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* 11. The agency representatives (case worker, foster parents, youth care specialist, etc.) I work with respect my ethnic background (me)?

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* 12. How can we improve our services?

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* 13. Do you have any additional comments?

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* 14. Would you like someone to contact you to speak with you more about what you have shared on this survey?

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* 15. If you answered Yes to the previous question, please provide your name and a phone number you may be reached at.

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