Cheyenne River Youth & Young Adult Housing Needs Survey

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1. Date (Required.)

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2. Name (optional)

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3. Age (Required.)

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4. Gender (Required.)

Male

Female

Non-binary

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5. Community you are from (Required.)

Current Housing Situation

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6. Which of the following best describes your current housing situation?

Living with relatives or extended family

Staying with friends (couch surfing)

Living in a shelter or housing program

Living in a vehicle, outdoors, or another temporary location

Other (please specify)

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7. Where did you stay last night?

Emergency shelter

Friends or family member’s home

Outdoors or on the street

Transitional housing

Other (please specify)

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8. Do you have children?

Yes

If Yes, how many children do you have?

Basic Needs & Safety

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9. Do you currently have access to basic necessities (clothing, hygiene products, personal care items, etc.)?

Yes

Sometimes

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10. In the past 30 days, have you worried about or experienced not having enough food to eat?

Never

Sometimes

Often

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11. Do you have any comments about question 10, please share (optional)

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12. Do you feel safe where you are currently staying?

Yes

Sometimes

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13. Do you have any comments about question 12, please share (optional)

Support System

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14. Do you have a trusted adult or support person you can talk to when you need help?

Yes

Service & Resources

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15. What services would be most helpful to you right now (Select all that apply)?

Housing assistance

Food assistance

GED preparation or educational support

Job training

Employment assistance

Mental health services

Education assistance

Other (please specify)

Additional Support Needs

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16. Have you ever experienced or are you currently experiencing exploitation, trafficking, or being forced to do things you do not want to do in exchange for money, shelter, food, transportation, or other necessities?

Yes

Prefer not to answer

Cheyenne River Youth & Young Adult Housing Needs Survey

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* 1. Date (Required.)

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* 2. Name (optional)

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* 3. Age (Required.)

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* 4. Gender (Required.)

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* 5. Community you are from (Required.)

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* 6. Which of the following best describes your current housing situation?

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* 7. Where did you stay last night?

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* 8. Do you have children?

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* 9. Do you currently have access to basic necessities (clothing, hygiene products, personal care items, etc.)?

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* 10. In the past 30 days, have you worried about or experienced not having enough food to eat?

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* 11. Do you have any comments about question 10, please share (optional)

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* 12. Do you feel safe where you are currently staying?

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* 13. Do you have any comments about question 12, please share (optional)

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* 14. Do you have a trusted adult or support person you can talk to when you need help?

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* 15. What services would be most helpful to you right now (Select all that apply)?

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* 16. Have you ever experienced or are you currently experiencing exploitation, trafficking, or being forced to do things you do not want to do in exchange for money, shelter, food, transportation, or other necessities?

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* 17. Do you have any comments about question 16, please share (optional)

1. Date (Required.)

2. Name (optional)

3. Age (Required.)

4. Gender (Required.)

5. Community you are from (Required.)

6. Which of the following best describes your current housing situation?

7. Where did you stay last night?

8. Do you have children?

9. Do you currently have access to basic necessities (clothing, hygiene products, personal care items, etc.)?

10. In the past 30 days, have you worried about or experienced not having enough food to eat?

11. Do you have any comments about question 10, please share (optional)

12. Do you feel safe where you are currently staying?

13. Do you have any comments about question 12, please share (optional)

14. Do you have a trusted adult or support person you can talk to when you need help?

15. What services would be most helpful to you right now (Select all that apply)?

16. Have you ever experienced or are you currently experiencing exploitation, trafficking, or being forced to do things you do not want to do in exchange for money, shelter, food, transportation, or other necessities?

17. Do you have any comments about question 16, please share (optional)