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Youth Foster Care Placement Experience
Have you been asked for input into decisions about your care?
Yes
No
Comments/ feedback?
I am able to participate with the following while I have been in foster care:
Yes
No
This does not apply to me
My regular schooling
Yes
No
This does not apply to me
Activities outside of school (examples would be sports, religious services, afterschool clubs)
Yes
No
This does not apply to me
My hygiene needs (examples would be preferred hair or shaving products, skincare or cosmetic products)
Yes
No
This does not apply to me
Visits to my family doctor or dentist
Yes
No
This does not apply to me
Spending time with my friends
Yes
No
This does not apply to me
Getting to talk with my birth family members
Yes
No
This does not apply to me
Celebrating special days (examples might be a birthday or holiday)
Yes
No
This does not apply to me
Are you treated with kindness in your foster home?
Yes
No
In my foster home:
Yes
No
This does not apply to me
I feel safe
Yes
No
This does not apply to me
I am comfortable talking to my foster parent about my thoughts and feelings
Yes
No
This does not apply to me
I can be alone if I need space
Yes
No
This does not apply to me
My background is respected (such as religious beliefs, customs and traditions, language)
Yes
No
This does not apply to me
Is there anything you would like to change in your foster home?
Is there anything you would like to do during family visits that you haven't had a chance to do?
Is there anything you would like to share about your experience in foster care?
