Youth Community Council SCORECARD Survey 1 Safety & Security

Youth Community Council SCORECARD Survey 1 Safety & Security

KUUMBA EFFECT, a program of BLACK 4 CHARITIES
A survey for 5th to 12th grade youth

(Youth grade at the time the survey is completed)
WHY HAVE A YOUTH COMMUNITY COUNCIL? It is an opportunity for kids to speak up and for the adults to listen.

This survey was created for 5th to 12th grade youth by our Youth Community Council made up of middle and high school students who feel these categories and questions are important.
TELL US ABOUT YOURSELF

Please fill out your information. No personal information will be shared.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Zip Code
Age
Grade Level
Gender Identity

Other
Racial / Ethnic Identity

Other
School District (WA Listed)
If not in Washington State, select the first choice: "*Not in WA"
School District Outside of WA
Wrte in the name of your school district
QUESTIONS: Safety & Security

Combined results will be shared. No personal information will be shared.
(IF YOU ARE ON A MOBILE DEVICE, TURN YOUR SCREEN TO SEE THE STAR RATINGS MORE CLEARLY).
Adults in my community take my security concerns seriously.

1 — I Strongly Disagree, 2 — I Disagree, 3 — I Am Not Sure, 4 — I Agree, 5 — I Strongly Agree
I know who to contact and where to go if I feel unsafe.

1 — I Strongly Disagree, 2 — I Disagree, 3 — I Am Not Sure, 4 — I Agree, 5 — I Strongly Agree
I can report bullying without fear of retaliation.

1 — I Strongly Disagree, 2 — I Disagree, 3 — I Am Not Sure, 4 — I Agree, 5 — I Strongly Agree
I feel safe using public spaces like libraries, parks, and comunity spaces.

1 — I Strongly Disagree, 2 — I Disagree, 3 — I Am Not Sure, 4 — I Agree, 5 — I Strongly Agree
I feel safe on the bus (school bus or public transportation)

1 — I Strongly Disagree, 2 — I Disagree, 3 — I Am Not Sure, 4 — I Agree, 5 — I Strongly Agree
I feel safe going from place to place on __________.

Other
My school takes real action when students report safety issues.

1 — I Strongly Disagree, 2 — I Disagree, 3 — I Am Not Sure, 4 — I Agree, 5 — I Strongly Agree
My school takes safety drills seriously (i.el: earthquake, fire, lockdown)

1 — I Strongly Disagree, 2 — I Disagree, 3 — I Am Not Sure, 4 — I Agree, 5 — I Strongly Agree
Have you ever felt threatened at school by a _____________?

Other
What type of security do you think is needed at your school?

Other
I know what to do if I experience bullying, harassment, threats, or inapprpriate behaior online.

1 — I Strongly Disagree, 2 — I Disagree, 3 — I Am Not Sure, 4 — I Agree, 5 — I Strongly Agree
My neighborhood would be a safer place if ______________________.

Other
Additional Comments or Thoughts
Feel free to share anything here.
How did you hear about this?

Other
Should be Empty:

Youth Community Council SCORECARD Survey 1 Safety & Security

A survey for 5th to 12th grade youth

WHY HAVE A YOUTH COMMUNITY COUNCIL? It is an opportunity for kids to speak up and for the adults to listen.

TELL US ABOUT YOURSELF

QUESTIONS: Safety & Security

(IF YOU ARE ON A MOBILE DEVICE, TURN YOUR SCREEN TO SEE THE STAR RATINGS MORE CLEARLY).