Massachusetts Youth Count Housing and Homelessness Survey 2018
This survey is being administered by the Massachusetts Special Commission on Unaccompanied Homeless Youth and the local Continuum of Care, so that the state and local providers can better understand the housing and service needs of youth and young adults under the age of 25 in Massachusetts. Over the past three years, the results of similar surveys have helped to push the Legislature to invest a total of $3.7 million in housing and services for young people who have experienced housing instability.

There are 31 questions. Your answers will remain confidential. Please respond to all of the questions you feel comfortable answering. We greatly appreciate your participation!


1. Have you already taken this survey in the past three weeks (or since April 23rd)?
2. What are your initials?
The first letter of each of your names: first/middle/last
Your answer
3a. What is your age? *
__ years old
Your answer
3b. What is your date of birth?
MM
/
DD
/
YYYY
4a. What is your primary language?
Your answer
4b. If your primary language is one other than English, are you taking this survey in your primary language?
We are asking the following set of questions to better understand your housing situation.
5. Where did you sleep last night? *
[CHECK ONE OPTION THAT BEST MATCHES YOUR ANSWER]
6. How long have you stayed/lived in the place you stayed last night?
7. Do you have a safe place where you can stay on a regular basis for at least the next 14 days?
8. Are you currently experiencing homelessness?
We are asking the following set of questions to learn if you are “accompanied”, that is living with your parent or guardian, and your history of being out on your own.
9a. Are you currently living with a parent, guardian or foster parent?
9b.If no, how old were you the first time you left home to be out on your own?
Your answer
9c. If no, how old were you when you left for good?
Your answer
10. If you are not living with your parent/guardian/foster parent now, what are the reasons? (CHECK ALL THAT APPLY)
We are asking the following set of questions to better understand your demographics (place of birth, age, education, income, etc.), as well as your experiences in trying to access needed resources.
11. Where were you born?
12. Which city/town are you in right now, taking this survey?
13a. Have you been staying overnight in the city/town where you are taking this survey?
13b. If no, what is the name of the city or town where you are staying?
Your answer
14. Do you have a high school diploma, HiSET degree, or GED?
15. Are you currently attending school or another education program?
16. Are you currently employed at a job for which you receive a pay stub or pay check?
17. Have you ever served in the U.S. Army, Navy, Marine Corps, Air Force, or Coast Guard?
18. Have you ever been in foster care?
19. Have you ever stayed overnight or longer in juvenile detention -- a secure facility or residential program for young people -- as a result of criminal behavior or police involvement?
20. Have you ever stayed overnight or longer in an adult jail or prison?
21a. Are you pregnant and/or parenting?
21b. If you are parenting, do you have custody of your child(ren)? In other words, are you responsible for caring for your child(ren) on a day-to-day basis?
22. What are your sources of income? [CHECK ALL THAT APPLY]
23. Have you ever exchanged sex (including sexual intercourse, oral sex, or any sexual interaction) for food, a place to stay, money, or other necessities?
24. In the last year, have you tried to get help from any of the following services/programs? [CHECK ALL THAT APPLY]
25. Did you get the help you needed?
26. If you did not receive all of the help you needed, why was that? [CHECK ALL THAT APPLY]
27. What is your race/ethnicity? [CHECK ALL THAT APPLY]
28. How would you describe your gender identity? [CHECK ALL THAT APPLY]
29. Which of the following best fits how you think about your sexual orientation? [CHECK ALL THAT APPLY]
30. Do you have any comments or insights you would like to share with the Massachusetts Commission on Unaccompanied Homeless Youth?
Your answer
31. Which of the following best describes how you were recruited to take this survey?
32. *For survey administrators/Youth Ambassadors only*: Was this survey taken by the Youth Count participant between April 23rd and May 13th? If not, please enter the survey date next to "other".
Thank you!
As noted above, all of your answers will remain confidential. Your participation is deeply appreciated and a key contribution in helping Massachusetts better understand housing instability among youth and young adults. For more information about this survey and the work to expand housing and resources for youth and young adults experiencing housing instability, please contact the Massachusetts Commission on Unaccompanied Homeless Youth: massachusettsyouthcount@gmail.com.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms