Youth Survey

WHY TRY

The Why Try Youth program, leaders, and its facilitators are committed to providing a high- quality resilience building program that helps youth learn the skills needed to cope with adversity and manage conflict. All responses will remain confidential and will be used to further improve the program. We appreciate your participation!

Name *

Gender *

Age *

Part I. Answer Yes or No to the following on adverse experiences in your personal life.

Do you know what ACEs (adverse childhood experiences) are? *YesNo

Have you ever been in a physical altercation? *YesNo

Have you ever witnessed a physical altercation? *YesNo

Have you ever misused alcohol or drugs? *YesNo

Have you ever witnessed a friend or loved one misuse alcohol or drugs? *YesNo

Have you ever witnessed or been a victim of violence in your neighborhood, community, or school? (such as bullying, assault, stalking, or other violent acts)? *YesNo

Are there any challenges you would like to change in your life? *YesNo

Part II. Answer questions related to how good or how poorly you believe you handle conflict and challenges in life.

How well do you believe you handle challenges in life? *

How well do you believe you handle conflict with peers, friends, and family? *

How well do you believe you manage your emotions during conflict? *

How well do you believe you control your anger during conflict? *

Part III. Answer the following about how you deal with conflict with your peers, friends, and family by responding with strongly agree; agree; neutral; disagree; strongly disagree.

I am frequently involved in conflicts with peers, friends, and family. *

In conflicts, I often feel like the people around me do not hear me or understand my point of view. *

I frequently feel like I have to raise my voice to be heard or to get my point across. *

When someone disagrees with me, I strongly feel the need to defend myself. *

I avoid conflict with peers, friends, and family most of the time. *

I go along with suggestions from peers, even if I don’t agree with them. *

I keep my opinions to myself rather than openly disagree with people. *

It is not worth my time openly discussing my disagreements with other people. *

I prefer to discuss disagreements with friends, family, and peers to uncover solutions that benefit both sides of the issue. *

Are there any specific skills you hope to learn in this program or challenges in your personal life you would like to discuss further? *YesNo

If Yes, please discuss here or leave contact information: