MaineYES Girl-Centered Listening Questionnaire Focus: Health, Connection & Well-Being Purpose: To understand girls’ lived experiences and use their voices to improve and design programs that support health, safety, belonging, and confidence during

🌱 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 NameLast Name
Date

MonthDayYear
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?

Have you ever experienced bullying at school?

Rows	Yes	No	Not Sure
Have you ever experienced bullying at school?

Name-callingBeing ignored or excludedBeing teased about culture, language, clothes, or accentOnline bullyingPhysical bullyingBeing teased about culture, language, clothes, or accent
SadAngryLonelyEmbarrassedConfused
FamilyTeacherFriendMaineYES staffNo 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)
Watch videos / phoneHomeworkPlay outsideSports/movementHelp familyOther
Less than 1 hour1–3 hoursMore than 3 hours
WalkingSoccerDancingGamesOtherNone
StrongTiredHappyStressedCalm
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?

FriendsFamilyCultureArt / MusicSportsHelping 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?
☐ Anti-bullying supportGirls’ leadership groupsSports or movementArt or cultural expressionSafe talking circlesHomework 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):
Team Leader☐ ☐ ☐Youth AdvisorProgram helperMentor 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?
Upload Pictures of your ECO-Girls Journal.

Cancelof
Any additional comments you wish to share?
Should be Empty:

🌱 Maine YES Girls-Centered Listening Questionnaire