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First Time Youth
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16
Questions
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1
Nice to meet you, What is your name?
First Name
Last Name
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2
What's your phone number?
Please enter a valid phone number.
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3
Email
example@example.com
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4
What are you most interested in learning more about?
Drop-in Space
Upcoming Music Workshops
Sewing
Screenprinting
Goal Setting
Academic Support
Case Management
Housing Navigation
Information Session
Public Advocacy
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5
Date of Birth
ex. 10/06/1992
/
Date
Month
Day
Year
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6
How old are you?
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7
What are your Preferred Pronouns?
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8
How do you identify your gender?
Cisgender Female
Cisgender Male
Nonbinary
Transfeminine
Transmasculine
Gender Queer
Agender
Other
Man
Woman
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9
How do you identify your sexual orientation?
Heterosexual
Lesbian
Gay
Queer
Pansexual
Bisexual
Two Spirit
Intersex
Asexual
Questioning
Prefer Not to Disclose
Other
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10
Race/Ethnicity
Black/African American
Latinx (e), Chicanx (e), Hispanic
Asian- Central Asian
Multi race
Pacific Islander
American Indigenous
Middle Eastern or North African
White
Alaska Native
Asian- Southeast Asian
Other
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11
What is your primary language?
English
Spanish
Mandarin
Cantonese
Tagalog
Vietnamese
Hmong
Punjabi
Khmer
Korean
Armenian
Farsi
Arabic
Russian, Ukrainian or other Slavic language
Another language
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12
Where do you live in the Bay Area?
Berekely
Oakland
Richmond
Hayward
San Leandro
Alameda
San Francisco
Other
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13
Who you consider yourself Unhoused?
YES
NO
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14
Would you consider yourself someone who lives with a disability experience?
YES
NO
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15
What is the highest level of education?
Elementary (K-5)
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade (Diploma)
GED
Vocational/Trade Degree-Certificate
Some College
Associates Degree
Bachelors Degree
Masters Degree
Doctoral Degree
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16
How did you find out about Youth Spirit Artworks?
Website
Social Media
Friend
Family
Tabling
Word of Mouth
Presentation
Teacher or Counselor
other
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