QUESTIONNARE

‬WHY ARE WE ASKING THESE QUESTIONS?:‬‭ We ask these questions‬‭ to better understand your‬ goals, interests, and any challenges you might be facing so we can offer meaningful and‬ personalized support. Your answers help us shape a program that reflects who you are and‬ what you care about. Participation is completely voluntary — you can skip any questions‬ you’re not comfortable answering. Your privacy and comfort are always our top priorities.‬

‭ AGE RESTRICTION:‬‭ If you are under 13 years of age, please have your parent or guardian‬ reach out to us directly so we can legally explore the options in order to provide our services.

PARTICIPANT INFO

FIRST NAME

LAST NAME

AGE

LOCATION

CURRENT GRADE & SCHOOL

PHONE

PREFERRED METHOD OF CONTACT

WHO SHOULD WE CONTACT IN CASE OF AN EMERGENCY? PLEASE PROVIDE THEIR NAME,‬ RELATIONSHIP & CONTACT INFORMATION

‭ IS THERE A TRUSTED ADULT, MENTOR OR ORGANIZATION YOU’D LIKE TO BE INVOLVED IN YOUR‬ ‭ ACTIVITIES WITH THIS PROGRAM? PLEASE PROVIDE THEIR NAME, RELATIONSHIP & CONTACT‬ ‭ INFORMATION:

DESCRIBE YOUR CURRENT LIVING SITUATION? (e.g., living with parents, guardians, in foster care, etc.):

HOW DID YOU HEAR ABOUT THE FIORE FOUNDATION?:

BACKGROUND INFO

WHAT’S SOMETHING THAT ALWAYS MAKES YOU SMILE OR LIFTS YOUR MOOD? (e.g., a song, a memory,‬ ‭ your pet, a favorite food)

WHAT MOTIVATES YOU TO KEEP GOING WHEN THINGS GET TOUGH? (e.g., your goals, family, music,‬ ‭ faith, making someone proud)

‭ WHAT ARE SOME STRENGTHS OR TALENTS YOU FEEL PROUD OF? (e.g., kindness, drawing, leadership,‬ ‭ problem-solving)

INTERESTS AND GOALS

ARE THERE ANY ACTIVITIES, CLUBS, OR TEAMS YOU’VE WANTED TO JOIN BUT COULDN’T DUE TO‬ ‭ FINANCIAL LIMITATIONS? PLEASE DESCRIBE ANY SPECIFIC OPPORTUNITIES YOU’VE MISSED OUT ON.

ARE THERE ANY CLASSES, WORKSHOPS, OR HOBBIES YOU'D LOVE TO TRY BUT HAVEN’T BEEN ABLE TO‬ ‭ BECAUSE OF COST? IF SO, WHAT ARE THEY? (e.g., music lessons, coding classes, art workshops)

IF YOU HAD NO FINANCIAL RESTRICTIONS, WHAT WOULD YOU MOST WANT TO EXPERIENCE OR LEARN?‬ ‭ THIS COULD BE ANYTHING FROM SPORTS TO ARTS TO ACADEMIC PURSUITS. FEEL FREE TO BE AS‬ ‭ SPECIFIC AS POSSIBLE.

WHAT ARE YOUR EDUCATIONAL AND CAREER GOALS? THESE CAN BE SHORT-TERM OR LONG-TERM‬ ‭ GOALS, RELATED TO SCHOOL, FUTURE CAREERS, OR PERSONAL ACHIEVEMENTS. LIST 3 - 5 GOALS.

CHALLENGES AND NEEDS

WHAT CHALLENGES ARE YOU CURRENTLY FACING IN YOUR PERSONAL LIFE, SCHOOL, OR‬ ‭ COMMUNITY?

‭ ON A SCALE OF 1 - 10, HOW WOULD YOU RATE YOUR OVERALL MOOD AND WELL-BEING OVER THE‬ ‭ PAST MONTH? (1 being very low, 10 being very high)r

ARE THERE ANY SPECIFIC AREAS WHERE YOU WOULD LIKE SUPPORT? (e.g., financial literacy, career‬ ‭ guidance, mental health, etc.) PLEASE LIST AS MANY AREAS AS YOU FEEL APPLY.

‭ WHAT RESOURCES OR SUPPORT DO YOU FEEL YOU NEED TO FULLY EXPLORE YOUR INTERESTS? (e.g.,‬ ‭ financial aid for classes, equipment for a sport, mentorship in a specific field).

WHAT ARE THE BIGGEST OBSTACLES YOU FEEL YOU NEED TO OVERCOME TO REACH YOUR GOALS?

ARE THERE ANY CHALLENGES THAT MIGHT MAKE IT HARD FOR YOU TO PARTICIPATE EVEN IF ACTIVITIES‬ ‭ ARE FREE? (e.g., transportation, lack of support at home, feeling nervous to try something new)

PROGRAM EXPECTATIONS

WHAT KIND OF EXPERIENCES WOULD YOU MOST LIKE TO GAIN FROM THIS PROGRAM? FEEL FREE TO LIST‬ ‭ MULTIPLE EXPERIENCES. THINK ABOUT BOTH PERSONAL AND PROFESSIONAL GROWTH. (e.g., joining a‬ ‭ sports team, attending a music class, participating in a science camp

HOW DO YOU THINK THESE EXPERIENCES WILL HELP YOU IN THE FUTURE? (e.g., gaining confidence,‬ ‭ building skills, discovering a career path, etc.)

WHAT WOULD MAKE THIS PROGRAM MOST HELPFUL TO YOU?

HOW DO YOU LEARN BEST?‬‭ (e.g., hands-on practice, group discussions, watching videos,‬ ‭ one-on-one)

ARE THERE THINGS THAT MAKE LEARNING HARDER FOR YOU? (e.g., reading instructions, noisy spaces,‬ working in groups)

AVAILABILITY AND COMMITMENT

‭ DO YOU HAVE ANY SCHEDULE PREFERENCES OR LIMITATIONS THAT MIGHT AFFECT YOUR‬ ‭ PARTICIPATION IN PROGRAM ACTIVITIES?

ARE YOU OPEN TO CHECKING IN WITH US REGULARLY AND GIVING FEEDBACK SO WE CAN MAKE THE‬ ‭ PROGRAM EVEN BETTER FOR YOU?

ADDITIONAL INFO

IS THERE ANYTHING ELSE YOU WOULD LIKE US TO KNOW ABOUT YOU? THIS COULD INCLUDE PERSONAL‬ ‭ INTERESTS, UNIQUE CHALLENGES, OR ANYTHING THAT HASN’T BEEN COVERED IN THE PREVIOUS‬ ‭ QUESTIONS.

DO YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT THE PROGRAM? WE’RE HERE TO HELP, SO‬ ‭ PLEASE FEEL FREE TO ASK ANYTHING THAT’S ON YOUR MIND.

WOULD YOU LIKE TO HELP SHAPE OR IMPROVE THIS PROGRAM FOR OTHER YOUNG PEOPLE LIKE YOU IN‬ ‭ THE FUTURE? (Yes / No / Maybe – explain)

‭ CONFIDENTIALITY‬‭ STATEMENT:‬‭ Your‬‭ privacy‬‭ and‬‭ well-being‬‭ are‬‭ very‬‭ important‬ to‬‭ us.‬‭ The‬‭ information‬‭ you‬‭ provide‬‭ in‬‭ this‬‭ questionnaire‬‭ will‬‭ be‬‭ kept‬‭ strictly‬ confidential‬‭ and‬‭ will‬‭ only‬‭ be‬‭ used‬‭ to‬‭ help‬‭ us‬‭ understand‬‭ how‬‭ we‬‭ can‬‭ best‬ support‬‭ you‬‭ in‬‭ the‬‭ program.‬‭ Your‬‭ responses‬‭ will‬‭ be‬‭ stored‬‭ securely‬‭ and‬‭ will‬‭ not‬ be‬‭ shared‬‭ with‬‭ anyone‬‭ outside‬‭ of‬‭ our‬‭ organization‬‭ without‬‭ your‬‭ permission,‬ except‬‭ in‬‭ cases‬‭ where‬‭ there‬‭ is‬‭ a‬‭ concern‬‭ for‬‭ your‬‭ safety‬‭ or‬‭ the‬‭ safety‬‭ of‬‭ others‬‭. If‬‭ you‬‭ have‬‭ any‬‭ questions‬‭ or‬‭ concerns‬‭ about‬‭ this,‬‭ please‬‭ feel‬‭ free‬‭ to‬‭ reach‬‭ out‬ to us.‬