Essex County Youth Survey
Are you moving around a lot, sleeping on a friend's couch, or staying in an empty building or another place not meant for human habitation? Maybe you are awake all night and sleeping in the library or somewhere else safe during the day. If this describes your situation then we hope you will fill out this brief, anonymous survey. We are a group of youth and housing advocates who are trying to push for more welcoming, affordable and accessible independent living opportunities for youth ages 16-24. Please take a few minutes to provide your feedback and experiences so we can work to providing the resources and supports you think we need more of!
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Please share your Date of Birth *
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Please provide the first 3 letters of your last name *
Have you taken this survey before? *
Do you have a safe place to sleep at night on a regular basis? *
Are there times when you do not know where you will sleep at night?
Clear selection
Where did you stay last night *
Can you live where you stayed last night for the next month
Clear selection
Where did you live in the last three months (Select all that apply) *
Required
How long have you been without a permanent place to live? *
City or Zip Code of last permanent address *
Have you ever lived in any of the following  *
Required
Where do you go to find housing resources? *
Where would you like to see information on housing resources shared? *
What is the answer that describes why you are not stably housed *
Are you currently pregnant? *
Do you have a child or children? *
If you have children do they reside with you?
Clear selection
Are you currently enrolled in school/vocational program? *
Please select any sources of income you receive *
Required
Do you have have Health Insurance? *
What is is your race? (Select all that apply) *
Required
Select Ethnicity *
Gender *
Sexual Orientation *
How would you rate your overall physical health? *
How would you rate your overall emotional health? *
Required
If you have any interest in learning more or participating in a Youth Action Board, a committee of young people with similar experiences which will inform Essex County officials regarding the needs of young people please share your email address below. 
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