Measure X Youth Centers Questionnaire

Question Title

1. Which age range do you fall under?

12-13

14-15

16-17

18-21

22-24

25+

Question Title

2. Are you a Contra Costa County resident? (Required.)

Yes

Question Title

3. In which part of the county do you reside? (Required.)

Central County (i.e. Concord, Pleasant Hill, Walnut Creek)

East County (i.e. Antioch, Brentwood, Pittsburg,

West County (i.e. Hercules, Pinole, Richmond)

I am not a Contra Costa County resident

Question Title

4. Which category best describes you? Select all that apply. (Required.)

Contra Costa County Youth

Parent/Guardian/Caretaker of Contra Costa Youth

Contra Costa County Educator

Contra Costa County Government

Contra Costa County Resident

Contra Costa County Business Owner

Community Based Organization

Other (please specify)

Question Title

5. Do you have questions about the Youth Centers? If yes, please list up to three

Question 1

Question 2

Question 3

Question Title

6. If yes, please provide your name, phone number, and email address below.

Name

Phone Number

Measure X Youth Centers Questionnaire

Question Title

* 1. Which age range do you fall under?

Question Title

* 2. Are you a Contra Costa County resident? (Required.)

Question Title

* 3. In which part of the county do you reside? (Required.)

Question Title

* 4. Which category best describes you? Select all that apply. (Required.)

Question Title

* 5. Do you have questions about the Youth Centers? If yes, please list up to three

Question Title

* 6. If yes, please provide your name, phone number, and email address below.

1. Which age range do you fall under?

2. Are you a Contra Costa County resident? (Required.)

3. In which part of the county do you reside? (Required.)

4. Which category best describes you? Select all that apply. (Required.)

5. Do you have questions about the Youth Centers? If yes, please list up to three

6. If yes, please provide your name, phone number, and email address below.