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SAMHSA Native Connections Tribal Youth Survey
1.
How old are you?
Under 10
11 – 14
15 – 19
20 – 24
Over 24
2.
What is your gender?
Male
Female
Transgender
Non-Binary
Prefer not to say
Other (please specify)
3.
Which of the following describes your ethnicity?
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Other (please specify)
4.
Are you a Saginaw Chippewa Tribal Member?
Saginaw Chippewa Tribal Member
Saginaw Chippewa Descendant
Member of another Tribe
Non-Native
5.
Please select the answer that best describes how much you participate in sports or working out. Artistic sports apply here (i.e; dance).
Not at all
Somewhat involved
Very involved
6.
Name a sport you enjoy if you answered either “somewhat involved” or “very involved” to the previous question. If your favorite sport isn’t listed below, please write your answer in the space provided. (select any that apply)
Kickboxing/MMA
Lacrosse
Dance (Non-Traditional/Modern or Traditional/Native American)
Basketball
Football
Soccer
I answered "not at all" to the previous question.
Other (please specify)
7.
What non-sports related activities do you enjoy? (select any that apply)
Creating Music (i.e; singing, drumming, instrument)
Painting
Writing Poetry or Stories
Drawing
Other (please specify)
8.
How many hours a day do you use technology? This includes social media and video games. (do NOT include technology for schoolwork)
0-5
6-11
12-17
18-23
9.
What events within the Tribe do you enjoy attending most, or would like to see return to our community? This could be related to culture/tradition, music, school, Ojibwe language, sports/activities, etc.
10.
Please select the answer that best describes how much you participate in tribal ceremonies, pow-wows, culture camps, or other cultural events.
Not at all
Somewhat involved
Very involved
11.
In the past 12 months, how many tribal ceremonies, pow-wows, culture camps, or other cultural events did you attend?
None
1 to 2
3 to 4
5 to 6
7 or more
12.
How interested are you in learning more about your Native American culture? 0 being "Not at All" and 10 being "Very Interested."
0
10
Clear
13.
How interested are you in learning and speaking the Ojibwe language? 0 being "Not at All" and 10 being "Very Interested."
0
10
Clear
14.
How important is it to you to maintain your Native American identity, values, and practices? 0 being "Not at All" and 10 being "Very Important."
0
10
Clear
15.
Are you, or someone you know, a victim of cyber bullying?
Yes
No
Unsure
16.
How frequent does bullying occur in your school?
Not Often At All
Somewhat Often
Every Day
Unsure
17.
How important is mental health to you? 0 being "Not at All" and 10 being "Very Important."
0
10
Clear
18.
How important is suicide prevention to you? 0 being "Not at All" and 10 being "Very Important."
0
100
Clear
19.
Do you currently, or have you ever, self-harmed?
Yes
No
20.
Have you ever attempted suicide?
Yes
No
21.
If you answered “yes” to the previous question, how long ago?
6 months ago or earlier
a year ago
more than 3 years ago
I answered “no” to the previous question.
22.
Who would you tell if you had thoughts of suicide? (select any that apply)
parents
grandparents (or other elders)
classmate
friends
clergy/traditional healer
healthcare provider/doctor
other family (siblings, cousins, etc)
nobody
23.
Do you, or your family, have a suicide prevention plan?
Yes
No
24.
Who are the role models in your life? (select any that apply)
parents
grandparents (or other elders)
classmate
friends
clergy/traditional healer
healthcare provider/doctor
other family (siblings, cousins, etc)
nobody
25.
In what ways can the Tribal community be more helpful to our youth in regard to mental health, suicide prevention or postvention, and awareness?
Current Progress,
0 of 25 answered
