Teen Pre-Internship Survey

Parent/Guardian Post-Internship Survey

Instructions: This survey is to be completed by the teen’s parent/guardian, NOT by the teen.
Date *

Month Day Year
Date
Name of Intern/Teen *

First Name Last Name
Name of Parent/Guardian Completing this survey *

First Name Last Name
Education & Psychosocial Information
Where does the teen attend school? *
What grade is the teen in? *
Describe the level of academic achievement. What is the teen's GPA? *
Does the teen have an IEP, is he/she enrolled in a curriculum based on intellectual or emotional disability? *
In the last 30 days, please estimate how many days of school your child has missed. *
Has your child been suspended, had any detentions or other school behavior issues since beginning the internship with BRF? Please explain. *
Is the teen involved with any CPS/CASA caseworkers? Please list the name, organization, and address. *
Has had any interaction with law enforcement since beginning the internship with BRF? If yes, please explain. *
Has the teen been a victim or perpetrator of emotional, physical or sexual abuse since beginning the internship with BRF? *
Drug and Alcohol Use
To your knowledge, does your teen currently use: *

Tobacco Opiates: Oxycontin, Heroin Abuse prescription pills Alcohol Cocaine Methamphetamine Marijuana Hallucinogens Other
Please explain any checked items (if other box was checked, please specify): *
Other Information
On a scale of 1-5, how was your teen's experience as a BRF intern? *
If you could use 1 word/1 sentence to describe your teen's experience as a BRF intern, what would it be? *
Did you see any improvement in your child's behavior and/or attitude while in the program? *
Would you recommend the BRF experience to another parent? *
Is there anything else you would like to tell us about your teen's experience with BRF? *
PROMIS SF 4a- Positive Affect
My child felt happy *

never rarely sometimes usually always
My child felt great *

never rarely sometimes usually always
My child felt cheerful *

never rarely sometimes usually always
My child felt joyful *

never rarely sometimes usually always
PROMIS SF 4a- Meaning & Purpose
My child felt hopeful about his/her future *

never rarely sometimes usually always
My child can reach his/her goals in life *

never rarely sometimes usually always
My child thinks his/her life is filled with meaning *

never rarely sometimes usually always
My child thinks his/her life has purpose *

never rarely sometimes usually always
PROMIS SF 8a- Anxiety
My child felt nervous *

never rarely sometimes usually always
My child felt scared *

never rarely sometimes usually always
My child felt worried *

never rarely sometimes usually always
My child felt like something awful might happen *

never rarely sometimes usually always
My child felt worried when he/she was at home *

never rarely sometimes usually always
My child got scared really easy *

never rarely sometimes usually always
My child worried about what could happen to him/her *

never rarely sometimes usually always
My child worried when he/she went to bed at night *

never rarely sometimes usually always
Should be Empty:

Parent/Guardian Post-Internship Survey

Education & Psychosocial Information

Drug and Alcohol Use

Other Information

PROMIS SF 4a- Positive Affect

PROMIS SF 4a- Meaning & Purpose

PROMIS SF 8a- Anxiety