SunServe Youth Services Survey

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1. How many SunServe activities have you attended in the past (Youth Groups, Personal Empowerment Groups, SocioDrama, etc.)?

How many SunServe activities have you attended in the past (Youth Groups, Personal Empowerment Groups, SocioDrama, etc.)?   Never attended before 1-5 6-14 15 or more

2. Please enter your contact information

Please enter your contact information   Name:
Email Address:

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3. Please tell us your age

Please tell us your age   Age:

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4. Please tell us how you identify your gender

Please tell us how you identify your gender   Male Female Transgender

Other (please specify)

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5. Please tell us how you identify your sexuality

Please tell us how you identify your sexuality   Gay Lesbian Bisexual Questioning

Other (please specify)

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6. Please check your Race/Ethnicity

Please check your Race/Ethnicity   Black/African American Native American White/Caucasian Asian American or Pacific Islander Black, Hispanic, Latino or Spanish Origin Caribbean White, Hispanic, Latino, or Spanish Origin

Other (please specify)

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7. Please check which City you live in

Please check which City you live in   Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Ft. Lauderdale Hallandale Beach Hillsboro Beach Hollywood Lazy Lakes Lauderdale by the Sea Lauderhill Lauderdale Lakes Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston West Park Wilton Manors

Other (please specify)

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8. Please answer these questions.

	Strongly Agree	Agree	Disagree	Strongly Disagree
While attending SunServe events I am treated well by representatives.	*Please answer these questions. While attending SunServe events I am treated well by representatives. Strongly Agree	While attending SunServe events I am treated well by representatives. Agree	While attending SunServe events I am treated well by representatives. Disagree	While attending SunServe events I am treated well by representatives. Strongly Disagree
While attending SunServe events I feel included and accepted by other youth.	While attending SunServe events I feel included and accepted by other youth. Strongly Agree	While attending SunServe events I feel included and accepted by other youth. Agree	While attending SunServe events I feel included and accepted by other youth. Disagree	While attending SunServe events I feel included and accepted by other youth. Strongly Disagree
Attending SunServe events has assisted me in learning skills to cope with my problems.	Attending SunServe events has assisted me in learning skills to cope with my problems. Strongly Agree	Attending SunServe events has assisted me in learning skills to cope with my problems. Agree	Attending SunServe events has assisted me in learning skills to cope with my problems. Disagree	Attending SunServe events has assisted me in learning skills to cope with my problems. Strongly Disagree
While at SunServe events I feel open to be myself and talk freely.	While at SunServe events I feel open to be myself and talk freely. Strongly Agree	While at SunServe events I feel open to be myself and talk freely. Agree	While at SunServe events I feel open to be myself and talk freely. Disagree	While at SunServe events I feel open to be myself and talk freely. Strongly Disagree
I fee like I belong to a community through my participation at SunServe.	I fee like I belong to a community through my participation at SunServe. Strongly Agree	I fee like I belong to a community through my participation at SunServe. Agree	I fee like I belong to a community through my participation at SunServe. Disagree	I fee like I belong to a community through my participation at SunServe. Strongly Disagree
Overall I feel better because of my participation in SunServe events.	Overall I feel better because of my participation in SunServe events. Strongly Agree	Overall I feel better because of my participation in SunServe events. Agree	Overall I feel better because of my participation in SunServe events. Disagree	Overall I feel better because of my participation in SunServe events. Strongly Disagree

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9. Please answer these questions regarding how you felt BEFORE attending the SunServe activity

	Strongly Agree	Agree	Disagree	Strongly Disagree
1. I feel that I'm a person of worth, at least on an equal plane with others.	*Please answer these questions regarding how you felt BEFORE attending the SunServe activity 1. I feel that I'm a person of worth, at least on an equal plane with others. Strongly Agree	1. I feel that I'm a person of worth, at least on an equal plane with others. Agree	1. I feel that I'm a person of worth, at least on an equal plane with others. Disagree	1. I feel that I'm a person of worth, at least on an equal plane with others. Strongly Disagree
2. I feel that I have a number of good qualities.	2. I feel that I have a number of good qualities. Strongly Agree	2. I feel that I have a number of good qualities. Agree	2. I feel that I have a number of good qualities. Disagree	2. I feel that I have a number of good qualities. Strongly Disagree
3. All in all, I am inclined to feel that I am a failure.**	3. All in all, I am inclined to feel that I am a failure.** Strongly Agree	3. All in all, I am inclined to feel that I am a failure.** Agree	3. All in all, I am inclined to feel that I am a failure.** Disagree	3. All in all, I am inclined to feel that I am a failure.** Strongly Disagree
4. I am able to do things as well as most other people.	4. I am able to do things as well as most other people. Strongly Agree	4. I am able to do things as well as most other people. Agree	4. I am able to do things as well as most other people. Disagree	4. I am able to do things as well as most other people. Strongly Disagree
5. I feel I do not have much to be proud of.**	5. I feel I do not have much to be proud of.** Strongly Agree	5. I feel I do not have much to be proud of.** Agree	5. I feel I do not have much to be proud of.** Disagree	5. I feel I do not have much to be proud of.** Strongly Disagree
6. I take a positive attitude toward myself.	6. I take a positive attitude toward myself. Strongly Agree	6. I take a positive attitude toward myself. Agree	6. I take a positive attitude toward myself. Disagree	6. I take a positive attitude toward myself. Strongly Disagree
7. On the whole, I am satisfied with myself.	7. On the whole, I am satisfied with myself. Strongly Agree	7. On the whole, I am satisfied with myself. Agree	7. On the whole, I am satisfied with myself. Disagree	7. On the whole, I am satisfied with myself. Strongly Disagree
8. I wish I could have more respect for myself.**	8. I wish I could have more respect for myself.** Strongly Agree	8. I wish I could have more respect for myself.** Agree	8. I wish I could have more respect for myself.** Disagree	8. I wish I could have more respect for myself.** Strongly Disagree
9. I certainly feel useless at times.**	9. I certainly feel useless at times.** Strongly Agree	9. I certainly feel useless at times.** Agree	9. I certainly feel useless at times.** Disagree	9. I certainly feel useless at times.** Strongly Disagree
10. At times I think I am no good at all.**	10. At times I think I am no good at all.** Strongly Agree	10. At times I think I am no good at all.** Agree	10. At times I think I am no good at all.** Disagree	10. At times I think I am no good at all.** Strongly Disagree

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10. Please answer these questions regarding how you felt AFTER attending the SunServe activity

	Strongly Agree	Agree	Disagree	Strongly Disagree
1. I feel that I'm a person of worth, at least on an equal plane with others.	*Please answer these questions regarding how you felt AFTER attending the SunServe activity 1. I feel that I'm a person of worth, at least on an equal plane with others. Strongly Agree	1. I feel that I'm a person of worth, at least on an equal plane with others. Agree	1. I feel that I'm a person of worth, at least on an equal plane with others. Disagree	1. I feel that I'm a person of worth, at least on an equal plane with others. Strongly Disagree
2. I feel that I have a number of good qualities.	2. I feel that I have a number of good qualities. Strongly Agree	2. I feel that I have a number of good qualities. Agree	2. I feel that I have a number of good qualities. Disagree	2. I feel that I have a number of good qualities. Strongly Disagree
3. All in all, I am inclined to feel that I am a failure.**	3. All in all, I am inclined to feel that I am a failure.** Strongly Agree	3. All in all, I am inclined to feel that I am a failure.** Agree	3. All in all, I am inclined to feel that I am a failure.** Disagree	3. All in all, I am inclined to feel that I am a failure.** Strongly Disagree
4. I am able to do things as well as most other people.	4. I am able to do things as well as most other people. Strongly Agree	4. I am able to do things as well as most other people. Agree	4. I am able to do things as well as most other people. Disagree	4. I am able to do things as well as most other people. Strongly Disagree
5. I feel I do not have much to be proud of.**	5. I feel I do not have much to be proud of.** Strongly Agree	5. I feel I do not have much to be proud of.** Agree	5. I feel I do not have much to be proud of.** Disagree	5. I feel I do not have much to be proud of.** Strongly Disagree
6. I take a positive attitude toward myself.	6. I take a positive attitude toward myself. Strongly Agree	6. I take a positive attitude toward myself. Agree	6. I take a positive attitude toward myself. Disagree	6. I take a positive attitude toward myself. Strongly Disagree
7. On the whole, I am satisfied with myself.	7. On the whole, I am satisfied with myself. Strongly Agree	7. On the whole, I am satisfied with myself. Agree	7. On the whole, I am satisfied with myself. Disagree	7. On the whole, I am satisfied with myself. Strongly Disagree
8. I wish I could have more respect for myself.**	8. I wish I could have more respect for myself.** Strongly Agree	8. I wish I could have more respect for myself.** Agree	8. I wish I could have more respect for myself.** Disagree	8. I wish I could have more respect for myself.** Strongly Disagree
9. I certainly feel useless at times.**	9. I certainly feel useless at times.** Strongly Agree	9. I certainly feel useless at times.** Agree	9. I certainly feel useless at times.** Disagree	9. I certainly feel useless at times.** Strongly Disagree
10. At times I think I am no good at all.**	10. At times I think I am no good at all.** Strongly Agree	10. At times I think I am no good at all.** Agree	10. At times I think I am no good at all.** Disagree	10. At times I think I am no good at all.** Strongly Disagree

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11. Please answer these questions regarding how you felt BEFORE attending the SunServe activity

	Hardly Ever	Some of the Time	Often
1. How often do you feel that you lack companionship?	*Please answer these questions regarding how you felt BEFORE attending the SunServe activity 1. How often do you feel that you lack companionship? Hardly Ever	1. How often do you feel that you lack companionship? Some of the Time	1. How often do you feel that you lack companionship? Often
2. How often do you feel left out?	2. How often do you feel left out? Hardly Ever	2. How often do you feel left out? Some of the Time	2. How often do you feel left out? Often
3. How often do you feel isolated from others?	3. How often do you feel isolated from others? Hardly Ever	3. How often do you feel isolated from others? Some of the Time	3. How often do you feel isolated from others? Often

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12. Please answer these questions regarding how you felt AFTER attending the SunServe activity

	Hardly Ever	Some of the Time	Often
1. How often do you feel that you lack companionship?	*Please answer these questions regarding how you felt AFTER attending the SunServe activity 1. How often do you feel that you lack companionship? Hardly Ever	1. How often do you feel that you lack companionship? Some of the Time	1. How often do you feel that you lack companionship? Often
2. How often do you feel left out?	2. How often do you feel left out? Hardly Ever	2. How often do you feel left out? Some of the Time	2. How often do you feel left out? Often
3. How often do you feel isolated from others?	3. How often do you feel isolated from others? Hardly Ever	3. How often do you feel isolated from others? Some of the Time	3. How often do you feel isolated from others? Often

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13. Please answer these questions regarding how you felt BEFORE attending the SunServe activity

	Always or Almost Always	Mostly	Sometimes	Rarely	Never or Almost Never
1. I focus on the good things in life, not just the problems.	*Please answer these questions regarding how you felt BEFORE attending the SunServe activity 1. I focus on the good things in life, not just the problems. Always or Almost Always	1. I focus on the good things in life, not just the problems. Mostly	1. I focus on the good things in life, not just the problems. Sometimes	1. I focus on the good things in life, not just the problems. Rarely	1. I focus on the good things in life, not just the problems. Never or Almost Never
2. I make changes in my life so I can live successfully with my emotional or mental health challenges.	2. I make changes in my life so I can live successfully with my emotional or mental health challenges. Always or Almost Always	2. I make changes in my life so I can live successfully with my emotional or mental health challenges. Mostly	2. I make changes in my life so I can live successfully with my emotional or mental health challenges. Sometimes	2. I make changes in my life so I can live successfully with my emotional or mental health challenges. Rarely	2. I make changes in my life so I can live successfully with my emotional or mental health challenges. Never or Almost Never
3. I feel I can take steps toward the future I want.	3. I feel I can take steps toward the future I want. Always or Almost Always	3. I feel I can take steps toward the future I want. Mostly	3. I feel I can take steps toward the future I want. Sometimes	3. I feel I can take steps toward the future I want. Rarely	3. I feel I can take steps toward the future I want. Never or Almost Never
4. I worry that difficulties related to my sexuality/	4. I worry that difficulties related to my sexuality/ Always or Almost Always	4. I worry that difficulties related to my sexuality/ Mostly	4. I worry that difficulties related to my sexuality/ Sometimes	4. I worry that difficulties related to my sexuality/ Rarely	4. I worry that difficulties related to my sexuality/ Never or Almost Never
gender identity will keep me from having a good life.	gender identity will keep me from having a good life. Always or Almost Always	gender identity will keep me from having a good life. Mostly	gender identity will keep me from having a good life. Sometimes	gender identity will keep me from having a good life. Rarely	gender identity will keep me from having a good life. Never or Almost Never
5. I know how to take care of my mental or emotional health.	5. I know how to take care of my mental or emotional health. Always or Almost Always	5. I know how to take care of my mental or emotional health. Mostly	5. I know how to take care of my mental or emotional health. Sometimes	5. I know how to take care of my mental or emotional health. Rarely	5. I know how to take care of my mental or emotional health. Never or Almost Never
6. When problems arise with regarding my sexuality/gender identity, I handle them pretty well.	6. When problems arise with regarding my sexuality/gender identity, I handle them pretty well. Always or Almost Always	6. When problems arise with regarding my sexuality/gender identity, I handle them pretty well. Mostly	6. When problems arise with regarding my sexuality/gender identity, I handle them pretty well. Sometimes	6. When problems arise with regarding my sexuality/gender identity, I handle them pretty well. Rarely	6. When problems arise with regarding my sexuality/gender identity, I handle them pretty well. Never or Almost Never
7. I feel my life is under control.	7. I feel my life is under control. Always or Almost Always	7. I feel my life is under control. Mostly	7. I feel my life is under control. Sometimes	7. I feel my life is under control. Rarely	7. I feel my life is under control. Never or Almost Never

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14. Please answer these questions regarding how you felt AFTER attending the SunServe activity

	Always or Almost Always	Mostly	Sometimes	Rarely	Never or Almost Never
1. I focus on the good things in life, not just the problems.	*Please answer these questions regarding how you felt AFTER attending the SunServe activity 1. I focus on the good things in life, not just the problems. Always or Almost Always	1. I focus on the good things in life, not just the problems. Mostly	1. I focus on the good things in life, not just the problems. Sometimes	1. I focus on the good things in life, not just the problems. Rarely	1. I focus on the good things in life, not just the problems. Never or Almost Never
2. I make changes in my life so I can live successfully with my emotional or mental health challenges.	2. I make changes in my life so I can live successfully with my emotional or mental health challenges. Always or Almost Always	2. I make changes in my life so I can live successfully with my emotional or mental health challenges. Mostly	2. I make changes in my life so I can live successfully with my emotional or mental health challenges. Sometimes	2. I make changes in my life so I can live successfully with my emotional or mental health challenges. Rarely	2. I make changes in my life so I can live successfully with my emotional or mental health challenges. Never or Almost Never
3. I feel I can take steps toward the future I want.	3. I feel I can take steps toward the future I want. Always or Almost Always	3. I feel I can take steps toward the future I want. Mostly	3. I feel I can take steps toward the future I want. Sometimes	3. I feel I can take steps toward the future I want. Rarely	3. I feel I can take steps toward the future I want. Never or Almost Never
4. I worry that difficulties related to my sexuality/	4. I worry that difficulties related to my sexuality/ Always or Almost Always	4. I worry that difficulties related to my sexuality/ Mostly	4. I worry that difficulties related to my sexuality/ Sometimes	4. I worry that difficulties related to my sexuality/ Rarely	4. I worry that difficulties related to my sexuality/ Never or Almost Never
gender identity will keep me from having a good life.	gender identity will keep me from having a good life. Always or Almost Always	gender identity will keep me from having a good life. Mostly	gender identity will keep me from having a good life. Sometimes	gender identity will keep me from having a good life. Rarely	gender identity will keep me from having a good life. Never or Almost Never
5. I know how to take care of my mental or emotional health.	5. I know how to take care of my mental or emotional health. Always or Almost Always	5. I know how to take care of my mental or emotional health. Mostly	5. I know how to take care of my mental or emotional health. Sometimes	5. I know how to take care of my mental or emotional health. Rarely	5. I know how to take care of my mental or emotional health. Never or Almost Never
6. When problems arise with regarding my sexuality/gender identity, I handle them pretty well.	6. When problems arise with regarding my sexuality/gender identity, I handle them pretty well. Always or Almost Always	6. When problems arise with regarding my sexuality/gender identity, I handle them pretty well. Mostly	6. When problems arise with regarding my sexuality/gender identity, I handle them pretty well. Sometimes	6. When problems arise with regarding my sexuality/gender identity, I handle them pretty well. Rarely	6. When problems arise with regarding my sexuality/gender identity, I handle them pretty well. Never or Almost Never
7. I feel my life is under control.	7. I feel my life is under control. Always or Almost Always	7. I feel my life is under control. Mostly	7. I feel my life is under control. Sometimes	7. I feel my life is under control. Rarely	7. I feel my life is under control. Never or Almost Never

15. If you feel this program has made a difference, please share your story

If you feel this program has made a difference, please share your story