IYAS Self Report (Probation)

INDIANA YOUTH ASSESSMENT SYSTEM

DISPOSITION TOOL SELF REPORT QUESTIONNAIRE
Name
DOB
Date

MonthDayYear
Date
Which Probation Officer are you meeting with?
Please fill out this form to the best of your ability. Your responses will be used to help make the best decisions regarding your situation.
How old were you when you first got in trouble with the law?
Please briefly describe what you did to get in trouble.
My family is important to me.
How likely are you to follow your parents rules?
How often do you get into arguments with adults?
My family wants me to stop getting in trouble.
My friends get into physical fights.
Have you ever been arrested with any of your friends?
My friends/family are part of a gang.
My friends are important to me.
How many times have you been suspended from school?
When was the last time you were suspended?
How many times have you been expelled from school?
How many of your teachers or other school staff do you have a positive relationship with?
Have you ever been employed?
If you have been employed, how did you get a long with your boss?
How old were you the first time you used drugs?
When was the last time you used drugs?
When was the last time you used alcohol?
How likely are you to quit using drugs?
On a scale of 1 to 10 rate yourself on how cool you are, with 10 being the most cool.
On a scale of 1 to 10 how cool would your friends rate you, with 10 being the most cool.
I can stop breaking the law.
There are some good things about gangs.
I am friends with people in a gang.
Have you experienced any of the following?
Neglect
Sexual Abuse
Physical Abuse
Should be Empty:

INDIANA YOUTH ASSESSMENT SYSTEM