* 1. Please check the status that applies:

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

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

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

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

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

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

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

T