i. instructions 1 . instructions 1 ii. survey 3 ... foster father my boyfriend/girlfriend/spouse ......

Download I. Instructions 1 . Instructions 1 II. Survey 3 ... Foster father My boyfriend/girlfriend/spouse ... I didn’t feel my classes were worthwhile

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  • 2

  • I. Instructions 1

    II. Survey 3

    Contents

  • 1

    Thank you for taking part in this survey!

    This is not a test. There are no right or wrong answers. The survey is anonymous, which means

    it does not have your name or any identifying information. Your answers will remain secret. They

    will be seen only by our research team and will not be read by anyone connected with your

    school or your home.

    Some questions may seem similar to each other but they are each a little different. All of the

    questions in the survey are important and have their own purpose. We ask that you read each

    question carefully and answer the best you can.

    If you dont find an answer that fits exactly, select the one that makes the most sense. Please

    answer all questions truthfully.

    INSTRUCTIONS

    Please read each question carefully and mark your answer by putting an X in the box next to the

    answer you choose. Make sure to mark only one answer for each question unless it says you can

    mark more than one. If you make a mistake or want to change your answer, completely fill in the

    box with the wrong answer and put an X in the box next to your new answer.

    Some of the questions will look like this:

    Q1 How many times have you watched TV this week?

    None

    1 or 2 times

    3 or 4 times

    5 or more times

    Other questions will look like this:

    (For each, please mark an X in the box under your answer.) NO! no yes YES!

    a. I like to eat pizza

    Mark the big NO! if you think the statement is definitely not true for you.

    Mark the little no if you think the statement is mostly not true for you.

    Mark the little yes if you think the statement is mostly true for you.

    Mark the big YES! if you think the statement is definitely true for you.

    Mark your choice by making an X in the box that is next to the answer

    you want.

  • 2

    Please try to answer every question. If you decide not to answer a question, draw an X through the

    question number.

    For questions that look like this:

    Q1 How many times have you watched TV this week?

    None

    1 or 2 times

    3 or 4 times

    5 or more times

    For questions that look like this:

    (For each, please mark an X in the box under your answer.) NO! no yes YES!

    b. I like to eat pizza

  • 3

    Survey

    Q1 What grade are you in?

    6th

    7th

    8th

    9th

    10th

    11th

    12th

    Q2 How old are you?

    10

    11

    12

    13

    14

    15

    16

    17

    18

    19 or older

    Q3 Are you...

    Female?

    Male?

  • 4

    Q4 Are you Spanish, Hispanic or Latino?

    No, not Spanish, Hispanic or Latino

    Yes, Mexican American

    Yes, Mexican

    Yes, Chicano

    Yes, Puerto Rican

    Yes, Cuban

    Yes, Central or South American

    Yes, other Spanish, Hispanic or Latino

    Q5 What is your race? (Select one or more)

    White, Caucasian or European

    Black, African American or African

    Asian or Asian American:

    Chinese

    Korean

    Cambodian

    Japanese

    Asian Indian

    Vietnamese

    Other Asian

    American Indian or Alaskan Native

    Native Hawaiian or other Pacific Islander:

    Filipino

    Hawaiian

    Samoan

    Guamanian

    Other Pacific Islander

    Other (Please specify)

  • 5

    Q6 Please choose the ONE answer that BEST describes what you consider yourself to be.

    White, not of Hispanic Origin

    Black, African American or African

    Spanish, Hispanic or Latino

    Asian or Pacific Islander

    American Indian, Native American, Eskimo or Aleut

    Multiracial or biracial

    Other (Please specify)

    Q7 Think of where you live most of the time. Which best describes your living situation? (Select only one option.)

    House, apartment or condo

    Residential or group home away from parents or family

    Moving around from place to place

    Living out of a car or living on the street

    Other living situation (Please specify)

  • 6

    Q8 Which of the following people live there with you? Choose all that apply.

    Mother Uncle

    Father Sister(s)

    Stepmother Stepsister(s)

    Stepfather Brother(s)

    Adoptive mother Stepbrother(s)

    Adoptive father Friend(s)

    Foster mother Other adults not related to me

    Foster father My boyfriend/girlfriend/spouse

    My parent's boyfriend/ girlfriend/partner

    My biological children

    Grandmother Other children not related to me

    Grandfather Other (Please specify)

    Aunt __________________________

    Q9 In which neighborhood do you live? (Choose the ONE best answer)

    Blackstone East Side Olneyville Manton

    College Hill East Side West End Mount Pleasant

    Fox Point East Side Federal Hill Reservoir

    Hope (Summit) East Side

    Elmwood South Side Silver Lake

    Mount Hope East Side

    South Providence South Side

    Smith Hill

    Wayland East Side Downtown South Elmwood

    Charles North End Elmhurst Valley

    Wanskuck North End Chad Brown Housing

    Hartford Washington Park

    Q10 What is the zip code where you live?

  • 7

    Q11 What is the language you use the most at home?

    English

    Spanish

    Another language (Please write in)

    Q12 How many times have you changed homes since kindergarten?

    Never

    1 or 2 times

    3 or 4 times

    5 or 6 times

    7 or more times

    Q13 Have you changed homes in the past year (12 months)?

    Yes

    No

    Q14 Have you ever spent time in foster care?

    Yes

    No

    Q15 In the past year (12 months), how much time did you spend in foster care?

    None in the past year

    One week or less

    More than a week but less than a month

    Between one and four months

    More than four months and less than six months

    Six months or more

  • 8

    Q16 Have you ever spent time in a juvenile detention center ('juvy') or a juvenile or adult correctional center?

    Yes

    No

    Q17 In the past year (12 months), how much time did you spend there?

    None in the past year

    One week or less

    More than a week but less than a month

    Between one and four months

    More than four months and less than six months

    Six months or more

    The next questions ask about your experiences at school.

    Q18 Putting them all together, what were your grades like last year?

    Mostly F's

    Mostly D's

    Mostly C's

    Mostly B's

    Mostly A's

    Q19 Are your school grades better than the grades of most students in your class?

    NO!

    no

    yes

    YES!

    Q20 Have you ever been held back a year in school (repeated a grade)?

    Yes

    No

  • 9

    Q21 How many times have you changed schools (including changing from elementary to middle or middle to high school) since kindergarten?

    Never

    1 or 2 times

    3 or 4 times

    5 or 6 times

    7 or more times

    Q22 Have you changed schools (including changing from elementary to middle or middle to high school) in the past year (12 months)?

    Yes

    No

    Q23 How many times in the past year (12 months) have you been suspended or expelled from school?

    Never

    1 or 2 times

    3 to 5 times

    6 to 9 times

    10 to 19 times

    20 to 29 times

    30 to 39 times

    40+ times

    Q24 During the last four weeks, how many whole days of school have you missed...

    (For each, please mark an X in the box under your answer.)

    None 1 day 2 days 3 days 4-5 days

    6-10 days

    11 or more days

    a. ...because of illness or injury?

    b. ...because you skipped or cut?

  • 10

    Q25 Please choose the answer that best describes the reasons for your school absences this past year.

    In the past year (12 months) I have missed the most days of school because

    I was sick

    Someone else in my family was sick

    I had to take care of family responsibilities (for example, watch my younger siblings)

    The weather was too bad to come to school

    I feared for my safety on the way to school

    I feared for my safety in school

    I didnt have a way to get to school

    I