* 1. Please tell us what grade you are in:

* 2. Please indicate your gender:

To ensure that WILS is offering programs and activities that are of interest to its youth, please
read the following lists and check off all that you would participate in. Feel free to write-in suggestions for any other programs/services of interest to you, too!

* 3. Self-Advocacy

* 4. Peer Support

* 5. Sports/Fitness Activities

* 6. IL Skills

* 7. Employment Skills

* 8. Drop-in Activities

* 9. Comments or additional suggestions:

* 10. Do you prefer to participate in activities that are:

What days of the week are you interested in participating in these activities? Check all that apply.

* 11. June through August

* 12. September through May

* 13. What is the best way to communicate what's happening for youth at WILS. Please check all that apply:

* 14. What method(s) of transportation do you think you will use to get to our centers? Please check all that apply:

* 15. In addition special activities may also be organized. Please check off all events that you would be interested in participating in and provide us with any additional comments or suggestions.

* 16. WILS will offer a variety of volunteer opportunities for you to become involved in. Please check all areas that you might be interested in volunteering for:

* 17. If you would like to be contacted about these volunteer opportunities or to further discuss this Needs Assessment, please provide your name and phone number:

T