Youth & Caregiver Resource Center Youth Resource Map Questionnaire

Prevention First's Youth & Caregiver Resource Center and The Illinois Family Resource Center are collaborating to create a resource map that will provide information to families and individuals looking for youth programs for youth impacted by parental or familial substance use. Program information will be displayed on the YCRC and Illinois Family Resource Center's web pages.

If you are aware of or part of an organization that provides programming to youth impacted by parental substance use, incarceration, or similar adverse experiences, please fill out the following questionnaire.

If you have any questions about the questionnaire, please contact the YCRC Administrator, Daniela Aguilar, at ycrc@prevention.org.

Question Title

* What is the name of your organization?

Question Title

* Please provide the following contact information for your organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* Does your youth program follow an evidence-based curriculum?

Yes

Other (please specify)

Question Title

* Please select which of the following audiences you serve

Children of incarcerated people

Children of people who use substances

Children who have been by violence

Families in early recovery/ re-entry

Other (please specify)

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* Does your program or organization offer therapeutic services for youth?

Yes, at no cost

Yes, at a cost

Other (please specify)

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* Please provide a brief description of your program (include program hours, age range, and daily activities)

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* We are joining with The Illinois Family Resource Center to create a resource list to be posted on both website resource pages. People could access this information if they are looking for assistance with addressing issues of youth experiencing the impact of SUDs in their family or environment. With your permission, Prevention First would like to list you as an available resource. Do you give Prevention First's Youth & Caregiver Resource Center permission to post your information on our website?

Yes