Foster Youth Exit Survey

This survey is for youth 18 and over exiting state's care. The information provided in this survey will help the state improve services and supports for transition age foster youth. Youth who complete this survey will receive a $100 E-Visa Gift Card. The gift card will be sent to the email address the youth provides in the survey, which must be their personal email address.

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* 1. What is today's date?

Date

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* 2. Survey Completed By:

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* 3. What is the youth's first name?

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* 4. What is the youth's last name?

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* 5. What is the youth's date of birth?

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* 6. What is the youth's age?

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* 7. What is the youth's email address?

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* 8. What is the youth's phone number?

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* 9. What is the youth's race?

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* 10. Last Placement Type (Placement type youth is leaving care from)

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* 11. For what reason is the youth leaving state's care?

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* 12. Where will the youth be living upon exit?

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* 13. If youth will be living in own apartment, did they obtain apartment through a subsidized program?

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* 14. If Yes, which one? (Scholar, Project Life, FUP, Etc.)

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* 15. What city will the youth be residing in upon exit?

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* 16. Did the youth leave state’s care at any point after turning 18 and later request to return to care?

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* 17. Does the youth have children or are they expecting a child?

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* 18. If youth has children, with whom will the children be living when the youth exit’s care?

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* 19. What is the highest grade the youth has completed?

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* 20. Has the youth earned a vocational certificate? 

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* 21. If yes, which one?

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* 22. Is the youth currently attending an educational program?

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* 23. If yes, what type of program (high school, GED program, college, vocational program, etc.)?

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* 24. If the youth is currently in college, what is their classification.

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* 25. Has the youth ever been charged with a crime as an ADULT?

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* 26. Does the youth currently have a bank account?

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* 27. Approximately how much money does the youth have saved in all places?

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* 28. Is the youth currently employed?

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* 29. If yes, How long has the youth been employed at their CURRENT job?

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* 30. If yes, is the youth working full-time or part-time?

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* 31. If yes, Is the youth earning more than the state minimum wage per hour ($7.25)?

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* 32. Does the youth have an original birth certificate, social security and a state issued ID?

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* 33. Does the youth have a Driver’s License?

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* 34. If no, does the youth have a Driving Learner’s Permit?

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* 35. Did the youth complete a Driver’s Education course?

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* 36. What is the youth’s primary mode of transportation?

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* 37. Is the youth currently taking any psychotropic medications?

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* 38. If yes, does the youth plan to continue taking medication after leaving care?

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* 39. Does the youth feel like they have a least one caring adult in their life?

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* 40. Is the youth interested in being contacted about available aftercare services and supports?

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* 41. Does youth feel prepared to live independently (pay your own bills etc.)?

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* 42. Why or why not?

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