Youth Services Center Student Survey 2021-22 High School

Thank you for completing and returning this survey to the Youth Services Center. Your answers will help us plan programs and services for the year.

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* 1. School Name

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* 2. Grade

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* 3. Who do you live with?

Both Parents (Same Household)

Both Parents (Living Apart)

Mother Only

Father Only

Grandparent(s)

Other Relative/Guardian

Foster Care

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* 4. What is the primary language spoken in your home?

English

Other (please specify)

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* 5. Do you have internet access at home?

Yes

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* 6. How many adults in your home are:

	0	1	2	3+
Working FULL time	Working FULL time 0	Working FULL time 1	Working FULL time 2	Working FULL time 3+
Retired	Retired 0	Retired 1	Retired 2	Retired 3+
Unemployed/looking for work	Unemployed/looking for work 0	Unemployed/looking for work 1	Unemployed/looking for work 2	Unemployed/looking for work 3+
Working PART time	Working PART time 0	Working PART time 1	Working PART time 2	Working PART time 3+
Disabled	Disabled 0	Disabled 1	Disabled 2	Disabled 3+

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* 7. Do you have a parent/guardian who is currently on military deployment?

Yes

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* 8. Do you have a parent/guardian currently in jail?

Yes

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* 9. What is your current medical insurance status?

Private Insurance

Medical Card/Passport/KCHIP

No Medical Insurance

Unsure

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* 10. Do you have feel there is a need for more after-school or summer enrichment?

Yes

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* 11. Do you have a paid job?

No, but I am looking

No, I am too young to work

No, I had one, but quit

No, I do not want a job right now

No, I had one, but was fired

Yes, I have a job

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* 12. If yes, how many hours do you work PER WEEK (on average)?

1-10 hours/week

11-20 hours/week

21-30 hours/week

I don't work

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* 13. Do you give money for family expenses (rent, utilities, food)?

Yes

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* 14. Are you confident in your job application, resume-writing, and/or interviewing skills?

Yes

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* 15. Do you feel confident in your College Application skills?

Yes

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* 16. What do you feel are your top three most important needs in order to make decisions about your future and/or college plans?

Exposure to various Career Choices

Career/Job Entrance Requirements

Internships/Cooperative Education Opportunities (Co-op)

Explanation of the various College Programs/Degree

Visits to College Campuses

College Entrance Requirments

Assistance with the College Application Process and FAFSA

College Scholarship Opportunities

Explanation of the KEES Funding

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* 17. Are you or your family currently facing any of the following basic needs situations? (Check all that apply)

Lack of Clothing/School Uniforms

Lack of School Supplies

Lack of Food

Homelessness/Eviction

Disconnected Utilities

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* 18. Are you or your family currently facing any of the following medical situations? (Check all that apply)

Immunization/Physicals NOT Current

Untreated Medical Problems

Untreated Dental Problems (cavities, mouth/tooth pain)

Untreated Vision Problems (need glasses)

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* 19. Are you or your family facing any of the following social/emotional situations? (Check all that apply)

Attendance/Truancy/Tardies

Anxiety/Stress

Bullying

Depression

Grief

Abandonment

Divorce

Bed Wetting

Learning Difficulties/Disorder

Tutoring/Homework Help

Lack of Self-Esteem

Cutting/Self-Harm

Eating Disorder/Self-Image

Drug/Alcohol Abuse

Physical/Sexual Abuse

Verbal/Emotional Abuse

Family/Domestic Violence

Suicidal Thoughts/Attempts

Anger Management

Peer Relationships

Social Media

Teenage Pregnancy

Gambling Problems

Running Away from Home

Gang Involvement

Involvement with Juvenile Court

Involvement with CPS

Out of Control Behavior

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* 20. If you could improve any of the following things about your life, which would be the top three most important things that you would like to improve:

Make better grades

Get along better with my parents

Get along better with my teachers

Make better decisions/choices

Not get into trouble as much

Get more sleep

Eat healthier foods

Have a healthier lifestyle

Get more exercise

Get along better with my friends

Have less anxiety (worry less)

Have more friends

Improve my health

Knowing what I want to do when I graduate high school and/or with my future

Be able to concentrate better/pay more attention

Have better organizational skills

Have more self-confidence

Feel better about myself

How to get along with the opposite sex

Be happier

Thank you for completing the survey!

Important: If you are in need of help or services right now, please call or stop by the Youth Services Center.