🌱 Maine YES Girls-Centered Listening Questionnaire
Purpose: To understand girls’ lived experiences and use their voices to improve and design programs that support health, safety, belonging, and confidence during critical developmental stages.
Name
First Name
Last Name
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
1️⃣ Feeling Safe & Belonging (Social Connection)
For all ages (simplify language for younger girls)
Do you feel safe at school most days?
Rows
YES
Sometimes
NO
Any thoughts?
Do you feel safe at school most days?
Is there at least one person at school you feel comfortable talking to?
Rows
Teacher
Friend
Counselor
No one
Is there at least one person at school you feel comfortable talking to?
When you are with other girls, do you feel:
Rows
Happy
Comfortable
Shy
Left out
Unsure
When you are with other girls, do you feel:
Where do you feel most like yourself?
Rows
School
Home
MaineYES
Community
Other
Where do you feel most like yourself?
2️⃣ Bullying & School Experience
Have you ever experienced bullying at school?
Rows
Yes
No
Not Sure
Have you ever experienced bullying at school?
If yes, what kind? (check all that apply)
Name-calling
Being ignored or excluded
Being teased about culture, language, clothes, or accent
Online bullying
Physical bullying
Being teased about culture, language, clothes, or accent
How did it make you feel?
Sad
Angry
Lonely
Embarrassed
Confused
Did you tell anyone?
Family
Teacher
Friend
MaineYES staff
No one
Older girls (10–16) – follow-up:
What do adults at school do well when bullying happens?
What do you wish they understood better?
3️⃣ Health & Daily Habits (Health Equity Focus)
what kind of activates do you do at home?
Watch videos / phone
Homework
Play outside
Sports/movement
Help family
Other
How much time do you spend on screens each day?
Less than 1 hour
1–3 hours
More than 3 hours
What kinds of movement do you enjoy?
Walking
Soccer
Dancing
Games
Other
None
How does your body usually feel?
Strong
Tired
Happy
Stressed
Calm
4️⃣ Culture, Identity & Voice
Do you feel proud of who you are and where you come from?
Rows
Yes
Sometimes
No
Do you feel proud of who you are and where you come from?
Do you feel comfortable sharing your culture at school?
Rows
Yes
Sometimes
No
Do you feel comfortable sharing your culture at school?
What makes you feel strong or confident?
Friends
Family
Culture
Art / Music
Sports
Helping others
Is there something about you that adults don’t always understand?
5️⃣ MaineYES Programs – Feedback & Improvement
(Directly supports funder language: “engaging the people we serve”)
Have you participated in Maine YES programs?
Rows
Yes
No
Have you participated in MaineYES programs?
What do you like most about Maine YES?
What could Maine YES do better for girls like you?
What new programs would you like Maine YES to create?
☐ Anti-bullying support
Girls’ leadership groups
Sports or movement
Art or cultural expression
Safe talking circles
Homework or school support
If Maine YES asked for your help to design a program, would you:
Rows
Say Yes
Maybe
No
If Maine YES asked for your help to design a program, would you:
6️⃣ Leadership & Participation (Youth Voice)
Older girls (10–16):
Would you like to be a:
Team Leader☐ ☐ ☐
Youth Advisor
Program helper
Mentor for younger girls
What changes would you like to see for girls in your community?
7️⃣ Closing (Healing-Centered)
What makes you feel happy or calm?
If you could tell adults one thing about being a girl your age, what would it be?
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