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Community Youth Center Survey 2022

If money weren't a concern, what could a Community Youth Center include?

This section is optional.

1. Age

2. What is your gender

3. Race/Ethnicity

4. Family Income

5. What language do you speak at home? (Check all that apply)

English
Spanish
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

6. I would like information on how I can participate in the Youth ad hoc Committee.

I would like information on how I can participate in the Youth ad hoc Committee

First Name

Last Name

Email Address

Phone Number

Mobile Phone

If you would like to enter the drawing for prizes please enter your Name and Contact Info. Your contact information will not be shared with others.

First Name

Last Name

Email Address

Phone Number

Mobile Phone

7. What is your family size?

8. How did you hear about this survey?

Please enter an 'other' value for this selection.

Are you employed? *This question is required.

How are you doing in school? *This question is required.

Do you have access to reliable internet? *This question is required.

Do you have access to a computer to do your assignments? *This question is required.

How often are you physically active? *This question is required.

Do you have access to healthy food? *This question is required.

Do you have a place to prepare food? *This question is required.

How often do you feel overwhelmed, frustrated or misunderstood? *This question is required.

Do you have access to privacy? *This question is required.

Do you feel disconnected from people? *This question is required.