ChildNet Child Satisfaction Survey 1. Please select the best answer for each question. Question Title * 1. Name (Optional): Question Title * 2. What is your age? (Required.) Under 8 9-12 13-15 16-17 18 & Over Question Title * 3. Gender: (Required.) Female Male Other (please specify) Question Title * 4. Ethnicity: (Required.) Please select one. African American/Black Asian Indian Cambodian Chinese Cuban Eastern European Filipino German Haitian Hispanic/Latino Hmong Italian Japanese Korean Laotian Mexican/Chicano/Mexican American Other Other Southeast Asian Puerto Rican Russian Thai Unknown Vietnamese Please select one. menu Question Title * 5. Race: (Required.) Please select one. American Indian/Alaskan Native Asian Black/African American White Please select one. menu Question Title * 6. Religious/Cultural Affiliation: Question Title * 7. What is your primary language? (Required.) English Creole Spanish Other Question Title * 8. Please enter your City/Town or indicate if you do not know. (Required.) Question Title * 9. Do you know your Child Advocate's name? (Required.) Yes No Question Title * 10. Do you know your Child Advocate's phone number? (Required.) Yes No Question Title * 11. Do you know why your Child Advocate visits you? (Required.) Yes No Question Title * 12. Does your Child Advocate spend time with you alone during visits to your home? (Required.) Yes No Question Title * 13. Does your Child Advocate talk to you about school? (Required.) Yes No (please explain): Question Title * 14. Are you happy where you live now? (Required.) Yes No No (please explain): Question Title * 15. Are you participating in Independent Living (IL) services? (Required.) Yes No I am under 13 years old I'm living with my parents, relative, or non-relative caregiver Question Title * 16. Do you identify as LGBTQ? Yes No Prefer Not to Answer Question Title * 17. Are you satisfied with the services that ChildNet is providing to you? (Required.) Yes No Question Title * 18. What do you like most about your Child Advocate? Question Title * 19. What would you like your Child Advocate to do or not do? Question Title * 20. How can ChildNet do better? Question Title * 21. How did you take this survey? (Required.) Computer Paper Phone In person Done