Vaux Youth Assessment
Please take a few moments to complete this survey
Name
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First Name
Last Name
Date
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Month
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Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
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Pre Assessment
Post Assessment
Vaux Social Support Record
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Not at all
Some
A lot
At school, there are adults I can talk to, who care about my feelings and what happens to me.
At school, there are adults I can talk to, who give good suggestions and advice about my problems.
At school, there are adults who help me with practical problems, like helping me get somewhere or helping with a project.
There are people in my family I can talk to, who care about my feelings and what happens to me.
There are people in my family I can talk to, who give good suggestions and advice about my problems.
There are people in my family who help me with practical problems, like helping me get somewhere or help me with a job or project.
I have friends I can talk to, who care about my feelings and what happens to me.
I have friends I can talk to, who give good suggestions and advice about my problems.
I have friends who help me with practical problems, like how to get somewhere, or help me with a job.
Calculation 1-6
Calculation 1-9
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