Youth Alliance, Youth Survey
Thank you for participating in Youth Alliance's Youth Survey. Your input is truly valuable in improving and developing programs available to help the community. All individual responses are confidential. Survey is intended for students ages 11-18.


You are invited to attend YA's Youth Voice: Art + Justice Exhibit on October 28, 2017 at 3pm at the Art Annex 217 Fifth Street, Hollister, CA where we will host an Open Mic, an art display and much more! Prizes may be claimed at Youth Alliance, 310 Fourth Street, Suite 101, Hollister, CA, within two weeks of being notified. Please remember and keep your PIN number for your records. In order to claim your prize, you must provide your PIN number to a Youth Alliance Staff.

Phone number (XXX-XXX-XXXX)
Your answer
PIN - Create a four (4) digit code.
Your answer
How old are you? (mm/dd/yy)
Your answer
Do you live in:
What gender do you identify with?
Are you enrolled or have you participated in any of the following Youth Alliance programs? Check all that apply.
Are you enrolled in school? Check all that apply.
What school do you attend?
Your answer
What grade are you in?
Are you pregnant or a teen parent?
During the past 30 days, have any of the following events happened to you AT SCHOOL? Check all that apply.
If you selected any of the above, how often did it occur in the past 30 days?
Your answer
Do you feel comfortable asking questions and getting help in class?
I can be myself without fear of judgement.
My opinions are respected and valued by adults AT HOME?
My opinions are respected and valued by adults AT SCHOOL?
Students are treated fairly when they break the rules.
When there is conflict between people, this school tries to make sure ALL SIDES are heard to help resolve the conflict?
Families feel welcome in the school.
My school has helped me think about and explore future career options.
Do you have access to a computer for school work?
In the event of a crisis, I know where to go.
I have access to resources that help me succeed in school.
Which of the following SERVICES would help you succeed in school and in your personal life? Check all that apply.
Which of the following TOOLS would help you succeed in school and in your personal life? Check all that apply.
Who do you go to if you need help with school, legal counsel or personal matters? Check all that apply.
Where do you spend your time after school?
Do you have access to resources such as contraception or pregnancy/STD prevention services?
On a scale from 1-10, how safe do you feel on campus on any given day? (With 1 being the least safe and 10 being the most safe)
Not safe
Very Safe
If you could change one thing at SCHOOL, what would it be?
Your answer
If you could change one thing in your COMMUNITY, what would it be?
Your answer
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