Life Needs and Support
Your input is important! This survey is designed to help us understand the resources, training, extracurricular programs, and housing support that you feel you need. Your responses are anonymous and will be used to improve support services.
Demographic Information
Age
*
Gender
*
Please Select
Man
Woman
Other: (Please State Below)
Other Please State Here:
Current Living Situation:
*
Please Select
Foster Home
Group Home
Transitional Housing
Independent Living
CouchSurfing
Other: (Please state below)
Other Please State Here:
Education and Training Needs
1. What educational resources do you feel you need more access to? (Select all that apply)
*
Tutoring
Job /Career Training
College/Career Counseling
Vocational Training
Scholarships/Financial Aid Guidance
Life Skills
Technology (Laptops/Internet)
Travel /Exposure /Field Trips/Study Abroad
Money Management
Social Skills
Professional Skills
Entrepreneurial Training
Other: (Please state below)
Other Please State Here:
Extracurricular Programs
1. What types of extracurricular activities interest you? (Select all that apply)
*
Sports and Recreation
Arts and Music
Academic Clubs
Mentorship Programs
Social/Support Groups
Etiquette /Life Skills
Travel /Exposure /Field Trips/Study Abroad
Support groups
Therapy
Other: (Please state below)
2. Are there any barriers that prevent you from participating in extracurricular activities?
*
Lack of transportation
Cost
Lack of awareness
Schedule conflicts
Confidence / Fearful to try
Don’t feel like you fit in
Other: (Please state below)
Other Please State Here:
4. Housing and Independent Living
1. What housing support do you feel would help you the most? (Select all that apply)
*
Affordable Housing Options
Help with Rent and Bills
Roommate Matching
Support with Landlord Communication
Other: (Please state below)
Other Please State Here:
2. How prepared do you feel about living independently after foster care?
*
Very prepared
Somewhat prepared
Neutral
Somewhat not prepared
Not prepared
Not Sure
5. Additional Comments: Is there anything else you would like to share about your needs or ideas for new programs and support services?
If we feel we can help with any of your needs, would you like for us to contact you (Optional)
Yes
No
If yes to the above please and you would like for us to contact you please provide contact information (Optional).
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: