Juvenile Justice Survey

What category best describes your age?

10-15

16-20

21-25

25+

What is your gender?

Male

Female

Do you have any siblings?

Yes

No

Have you ever experimented with Drugs or Alcohol? If so what type?

Yes

No

Type of Drugs.

Other

Who do you live with?

Parent

Grandparents

Aunts/Uncle

Other

How important do you think Education is?

Very Important

Semi Important

Not Important

No Feeling about Education

Do you ever feel like you want to harm yourself?

Yes

No

Sometimes

If you had the option of doing any career in your life, what would it be and why?

Other

Do you feel you are in need of any assistance or resources? Please explain

Other

Is there anything else you would like to add to this survey?

Other