JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Ubly 9th Grade Needs Assessment 2015
The Youth Advisory Committee for the Huron County Community Foundation is assessing each community's youth. Results will help us have a better understanding of what YOU! the youth identify as both issues and positives in your community. We are asking you to complete this survey with HONESTY. All responses will be kept confidential. Results will be presented in the spring/summer 2015.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Gender
*
Male
Female
Instructions
Your responses should be based on what you know or feel about your school/community.
Please rate every question from a 1 to 5 scale.
1 = Not a Problem
2 = Somewhat of a Problem
3 = Minor Problem
4 = A Problem
5 = Major Problem
Category: Drugs
Marijuana
*
Not a Problem
1
2
3
4
5
Major Problem
Prescription Drugs
*
Not a Problem
1
2
3
4
5
Major Problem
Other Drugs
*
Not a Problem
1
2
3
4
5
Major Problem
If you identified Other Drugs as a problem, please indicate what type of drug.
Your answer
Category: Alcohol
Binge Drinking
*
"The consumption of an excessive amount of alcohol in a short period of time."
Not a Problem
1
2
3
4
5
Major Problem
Alcohol Abuse
*
Not a Problem
1
2
3
4
5
Major Problem
Social Drinking
*
Not a Problem
1
2
3
4
5
Major Problem
Category: Tobacco
Cigarettes and Alternative Cigarettes
*
Including E-Cigarettes, Hookah, etc...
Not a Problem
1
2
3
4
5
Major Problem
Chewing Tobacco
*
Not a Problem
1
2
3
4
5
Major Problem
Category: Driving
Reckless Driving
*
Not a Problem
1
2
3
4
5
Major Problem
Distracted Driving
*
Not a Problem
1
2
3
4
5
Major Problem
Texting While Driving
*
Not a Problem
1
2
3
4
5
Major Problem
Drunk Driving
*
Not a Problem
1
2
3
4
5
Major Problem
Category: Technology
Cyber Bullying
*
Not a Problem
1
2
3
4
5
Major Problem
Sexting
*
Not a Problem
1
2
3
4
5
Major Problem
Texting During Class
*
Not a Problem
1
2
3
4
5
Major Problem
Plagiarism
*
"The practice of taking someone else's work or ideas and passing them off as one's own."
Not a Problem
1
2
3
4
5
Major Problem
Cheating
*
Not a Problem
1
2
3
4
5
Major Problem
Lack of Technology Resources at Home
*
Not a Problem
1
2
3
4
5
Major Problem
Lack of Access to Internet at Home
*
Not a Problem
1
2
3
4
5
Major Problem
Lack of Technology Resources at School
*
Not a Problem
1
2
3
4
5
Major Problem
Lack of Access to Internet at School
*
Not a Problem
1
2
3
4
5
Major Problem
Category: Economy
Jobs for Teens
*
Not a Problem
1
2
3
4
5
Major Problem
Economic Pressure at Home
*
Stress caused by family financial issues
Not a Problem
1
2
3
4
5
Major Problem
Ability to Access Adequate Clothing
*
Ability to access necessary clothing for the weather
Not a Problem
1
2
3
4
5
Major Problem
Access to School Food
*
Free or reduced lunch
Not a Problem
1
2
3
4
5
Major Problem
Lack of Nutritional Food at Home
*
Not a Problem
1
2
3
4
5
Major Problem
Category: Peer to Peer
Peer Pressure
*
Not a Problem
1
2
3
4
5
Major Problem
Harassment & Hazing
*
Activities that involve humiliation, torture, or embarrassment to initiate a member into a group
Not a Problem
1
2
3
4
5
Major Problem
Bullying
*
Not a Problem
1
2
3
4
5
Major Problem
Fighting
*
Not a Problem
1
2
3
4
5
Major Problem
Teen Suicide and/or Self Harm
*
Not a Problem
1
2
3
4
5
Major Problem
Eating Disorders
*
Not a Problem
1
2
3
4
5
Major Problem
Category: Relationships
Teen Pregnancy
*
Not a Problem
1
2
3
4
5
Major Problem
Sexually Transmitted Diseases
*
Not a Problem
1
2
3
4
5
Major Problem
Sexual Pressure
*
Not a Problem
1
2
3
4
5
Major Problem
Physical Abuse by Boyfriend/Girlfriend
*
Not a Problem
1
2
3
4
5
Major Problem
Mental Abuse by Boyfriend/Girlfriend
*
Not a Problem
1
2
3
4
5
Major Problem
Category: Home Environment
Large Population Living in Home
*
Overcrowded
Not a Problem
1
2
3
4
5
Major Problem
Lack of Family Support
*
Not a Problem
1
2
3
4
5
Major Problem
Threat of Losing Home
*
Not a Problem
1
2
3
4
5
Major Problem
Physical Abuse by Family Member
*
Not a Problem
1
2
3
4
5
Major Problem
Mental and/or Verbal Abuse by Family Member
*
Not a Problem
1
2
3
4
5
Major Problem
Lack of Home Utilities
*
Water, Heat, Electric, & Laundry
Not a Problem
1
2
3
4
5
Major Problem
Transportation From Home
*
Not a Problem
1
2
3
4
5
Major Problem
Category: School Environment
Pay to Play Fees for Sports
*
Not a Problem
1
2
3
4
5
Major Problem
Lack of Extracurricular Activities
*
Not a Problem
1
2
3
4
5
Major Problem
School Programs Being Cut
*
Not a Problem
1
2
3
4
5
Major Problem
Lack of Leadership Opportunities
*
Not a Problem
1
2
3
4
5
Major Problem
Access to Personal Counseling
*
Not a Problem
1
2
3
4
5
Major Problem
Access to School Counselors
*
Educational Purposes
Not a Problem
1
2
3
4
5
Major Problem
Scheduling
*
Not getting classes you want or need
Not a Problem
1
2
3
4
5
Major Problem
High Student to Teacher Ratio
*
Too many students in the classroom
Not a Problem
1
2
3
4
5
Major Problem
Outdated School Books
*
Not a Problem
1
2
3
4
5
Major Problem
People Stealing from Lockers
*
Not a Problem
1
2
3
4
5
Major Problem
Coming to School Events Under the Influence of Drugs and/or Alcohol
*
Not a Problem
1
2
3
4
5
Major Problem
Bringing Illegal Substances to School
*
Not a Problem
1
2
3
4
5
Major Problem
Quality of School Food
*
Not a Problem
1
2
3
4
5
Major Problem
Safety at School
*
Not a Problem
1
2
3
4
5
Major Problem
School Facilities
*
Not a Problem
1
2
3
4
5
Major Problem
Category: College Access
Lack of Scholarships
*
Not a Problem
1
2
3
4
5
Major Problem
Access to College Tours
*
Not a Problem
1
2
3
4
5
Major Problem
Lack of Career or College Fairs
*
Not a Problem
1
2
3
4
5
Major Problem
Family Support to Motivate Going to College
*
Not a Problem
1
2
3
4
5
Major Problem
Access to College Advising
*
Not a Problem
1
2
3
4
5
Major Problem
Cost of Attending College
*
Not a Problem
1
2
3
4
5
Major Problem
Do you plan on furthering your education after High School?
*
Yes
No
Which of the following categories is the biggest issue in your community?
*
Choose
Drugs
Alcohol
Tobacco
Driving
Technology
Economy
Peer to Peer
Relationships
Home Environment
School Environment
College Access
Category: Positives in Your Community
Please Select Your THREE Favorite Positives in Your Community
*
Sports Facilities
Good Friends
Youth Groups and Church
School Activities
Strong Family Relationships
Technology Availability
Feeling of Safety
Strong Sense of Community
People Helping Each Other
Required
What is your MOST favorite thing in your community
*
Choose
Sports Facilities
Good Friends
Youth Groups and Church
School Activities
Strong Family Relationships
Technology Availability
Feeling of Safety
Strong Sense of Community
People Helping Each Other
Are you familiar with the Huron County Community Foundation?
*
Yes
No
Are you familiar with the Youth Advisory Committee (YAC) ?
*
Yes
No
Is there any other NEGATIVE things in your community that effect you, not mentioned on this survey?
Your answer
Are there any other POSITIVE things in your community that effect you, not mentioned on this survey?
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of Huron County Economic Development Corporation.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report