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Shelter in Place Survey (for teens)
How do YOU feel about the shelter in place? Answer these questions below. *be specific*
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Email
*
Your email
What are you grateful for from this past week?
Your answer
What have you enjoyed doing this past week?
*
Your answer
Do you like the shelter in place?
*
Yes
No
State your opinion on the shelter in place order. (i.e how has your life been impacted because of it?)
*
Your answer
What is a typical day for you during the shelter in place?
Your answer
What is something new you've learned in the past week?
*
Your answer
What have you learned about yourself?
Your answer
What do you not like about the shelter in place? (state why)
Your answer
Do you agree that it is a good idea for everybody to be quarantined?
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Yes
No
State why you think it is or is not a good idea.
Your answer
Is having to stay at home for you hard, or is it easy? (state why)
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Your answer
Anything else?
Your answer
Name/email address
Your answer
Permission to share?
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No thank you.
Yes, but anonymously.
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