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* 1. Please check the status that applies:

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* 2. Do you feel you feel safe in your home? (If no please explain below)

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* 3. Do you feel safe in your school? (If no please explain below)

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* 4. Do you know who to go to if you need help?

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* 5. Do you feel safe in your neighborhood? (If no please explain below)

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* 6. Do you know where to get help in your Neighborhood?

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* 7. Do you feel your case manager responds to your needs or concerns?

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* 8. Does your case manager help you find programs or services in your community?

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