QUESTIONNARE

WHY ARE WE ASKING THESE QUESTIONS?: We ask these questions to better understand your role and how we can support you in assisting the youth participants effectively. Your responses help us tailor our resources to meet the unique needs of both you and the young people you support. Participation is entirely voluntary, and you may skip any questions you’re not comfortable answering. Your privacy and comfort are our top priorities. By sharing your insights, you help us shape a program that truly reflects and responds to the needs, challenges, and dreams of the young people we serve.

ADULT ALLY INFO

FIRST NAME

LAST NAME

PHONE

PREFERRED METHOD OF CONTACT

YOUTH PARTICIPATION INFO

NAME OF YOUTH

AGE OF YOUTH

CURRENT GRADE & SCHOOL

APPROXIMATELY HOW LONG HAVE YOU KNOWN THE YOUTH, AND IN WHAT CONTEXT (e.g., as a‬ ‭ teacher, relative, mentor, coach, etc.)?

DESCRIBE THE YOUTH’S LIVING SITUATION? (e.g., living with parents, guardians, in foster care, etc.)

TECH ACCESS & COMMUNICATION

DOES THE YOUTH HAVE REGULAR ACCESS TO A PHONE, COMPUTER, OR INTERNET?

ARE‬‭ THERE‬‭ ANY‬‭ COMMUNICATION‬‭ BARRIERS‬‭ WE‬‭ SHOULD‬‭ BE‬‭ AWARE‬‭ OF‬‭ (e.g.,‬‭ limited‬‭ tech‬‭ access,‬ ‭ language preferences, etc.)?

YOUTH BACKGROUND

WHAT ARE THE YOUTH’S HOBBIES & INTERESTS? PLEASE DESCRIBE ANY SPECIFIC ACTIVITIES THEY ARE‬ ‭ PASSIONATE ABOUT, WHETHER OR NOT THEY HAVE HAD THE CHANCE TO PARTICIPATE IN THEM

ARE THEY CURRENTLY INVOLVED IN ANY EXTRACURRICULAR ACTIVITIES? IF YES, PLEASE LIST THEM. IF‬ ‭ NOT, ARE THERE ACTIVITIES THEY’VE EXPRESSED INTEREST IN BUT HAVEN’T BEEN ABLE TO JOIN?

WHAT ARE THE YOUTH’S EDUCATIONAL OR CAREER GOALS AS YOU UNDERSTAND THEM?

HAVE FINANCIAL LIMITATIONS AFFECTED THEIR ABILITY TO PURSUE THESE GOALS? IF SO, HOW?

WHAT SKILLS OR EXPERIENCES DO YOU BELIEVE THE YOUTH WOULD BENEFIT FROM THROUGH THIS‬ ‭ PROGRAM? CONSIDER BOTH SKILLS THAT ALIGN WITH THEIR CURRENT GOALS AND EXPERIENCES THAT‬ ‭ MIGHT HELP THEM DISCOVER NEW INTERESTS OR PASSIONS.

CHALLENGES AND NEEDS

WHAT CHALLENGES IS THE YOUTH CURRENTLY FACING IN THEIR PERSONAL LIFE, SCHOOL, OR‬ ‭ COMMUNITY? PLEASE INCLUDE ANY FINANCIAL, SOCIAL, OR EMOTIONAL CHALLENGES THEY FACE.

ARE THERE SPECIFIC AREAS WHERE YOU BELIEVE THEY NEED SUPPORT?

WHAT DO YOU BELIEVE ARE THE BIGGEST OBSTACLES THE YOUTH NEEDS TO OVERCOME TO REACH THEIR GOALS?

CULTURAL OR IDENTITY CONSIDERATIONS

ARE‬‭ THERE‬‭ ANY‬‭ CULTURAL,‬‭ IDENTITY-BASED,‬‭ OR‬‭ ACCESSIBILITY‬‭ CONSIDERATIONS‬‭ YOU’D‬‭ LIKE‬‭ US‬‭ TO‬‭ BE‬ ‭ AWARE OF TO BETTER SUPPORT THE YOUTH?

ARE‬‭ THERE‬‭ SPECIFIC‬‭ VALUES,‬‭ PRACTICES,‬‭ OR‬‭ SENSITIVITIES‬‭ THAT‬‭ ARE‬‭ IMPORTANT‬‭ TO‬‭ THE‬‭ YOUTH‬‭ OR‬ ‭ THEIR FAMILY THAT WE SHOULD RESPECT OR ACCOMMODATE?

PROGRAM EXPECTATIONS

WHAT DO YOU HOPE THEY WILL ACHIEVE BY PARTICIPATING IN THE FIORE FOUNDATION’S PROGRAM?

WHAT WOULD MAKE THIS PROGRAM MOST HELPFUL FOR THE YOUTH FROM YOUR PERSPECTIVE? ARE‬ ‭ THERE PARTICULAR EXPERIENCES, SKILLS, OR TYPES OF SUPPORT YOU THINK WOULD BE ESPECIALLY‬ ‭ BENEFICIAL?

‭ AVAILABILITY AND COMMITMENT

‬ ‭ ARE YOU ABLE TO SUPPORT THE YOUTH’S REGULAR PARTICIPATION IN THE PROGRAM? (e.g., offering‬ ‭ encouragement, helping with scheduling, transportation, etc.) PLEASE DESCRIBE ANY SUPPORT YOU‬ ‭ PLAN TO PROVIDE.

ADDITIONAL INFO

IS THERE ANYTHING ELSE YOU WOULD LIKE US TO KNOW ABOUT THE YOUTH OR YOUR RELATIONSHIP‬ ‭ WITH THEM? THIS COULD INCLUDE INSIGHTS INTO THEIR PERSONALITY, STRENGTHS, CHALLENGES, OR‬ ‭ HOW YOU BELIEVE THEY WILL BENEFIT FROM THE PROGRAM.

DO YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT THE PROGRAM? WE VALUE YOUR INPUT AND‬ ‭ WANT TO ENSURE THAT BOTH YOU AND THEY FEEL COMFORTABLE AND CONFIDENT IN THE PROGRAM.

‭ CONFIDENTIALITY‬‭ STATEMENT:‬‭ We‬‭ prioritize‬‭ the‬‭ privacy‬‭ and‬‭ well-being‬‭ of‬‭ both‬ you‬‭ and‬‭ the‬‭ youth‬‭ participant.‬‭ The‬‭ information‬‭ you‬‭ provide‬‭ in‬‭ this‬‭ questionnaire‬ will‬‭ remain‬‭ strictly‬‭ confidential‬‭ and‬‭ will‬‭ be‬‭ used‬‭ solely‬‭ to‬‭ understand‬‭ how‬‭ best‬‭ to‬ support‬‭ the‬‭ youth‬‭ in‬‭ our‬‭ program.‬‭ Your‬‭ responses,‬‭ including‬‭ any‬‭ information‬ about‬‭ the‬‭ youth‬‭ participant,‬‭ will‬‭ be‬‭ securely‬‭ stored‬‭ and‬‭ not‬‭ shared‬‭ outside‬‭ our‬ organization‬‭ without‬‭ your‬‭ consent,‬‭ except‬‭ in‬‭ situations‬‭ where‬‭ there‬‭ is‬‭ a‬‭ concern‬ for‬‭ safety.‬‭ By‬‭ submitting‬‭ this‬‭ form,‬‭ you‬‭ confirm‬‭ that‬‭ you‬‭ have‬‭ the‬‭ youth’s‬‭ (or‬ their‬‭ legal‬‭ guardian’s)‬‭ consent‬‭ to‬‭ share‬‭ this‬‭ information‬‭ on‬‭ their‬‭ behalf.‬‭ If‬‭ you‬ have‬‭ any‬‭ questions‬‭ or‬‭ concerns,‬‭ please‬‭ feel‬‭ free‬‭ to‬‭ contact‬‭ us.‬‭ If‬‭ you‬‭ have‬‭ any‬ questions or concerns, please feel free to contact us