Pre Survey - Futures
Survey is completed upon participants enrollment, and once participants completes programming.
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Email *
Staff Member Completing Survey: *
Participant First and Last Name *
Address *
Date of Birth *
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Age *
Gender: *
Ethnicity *
Race *
Name of School Attending *
Last grade completed *
Are you employed? *
Why are you interested in joining MissionSAFE? *
What would you like to get out of joining MissionSAFE? *
Questions about your neighborhood
1. Do you feel safe in your neighborhood? *
2. Are you involved in any sorts, arts, recreation opportunities in your neighborhood? *
3. Are gangs active in your neighborhood? *
4. Are you street involved? *
 5. Is it easy to get drugs in your neighborhood? *
6. Is it easy to get guns in your neighborhood? *
7. Is it considered “OK” to be in a gang or crew in your neighborhood? *
Educational Information
8. Are you enrolled in elementary, middle or high school? *
9. If no, is the reason you are not in school because: you graduated, received your HiSET/GED, are enrolled in HiSET/GED, dropped out, or were expelled? *
10. During the last school year, about how many times were you absent from school without a doctor’s note or permission? *
11. During the last school year, how many days of school did you miss due to out-of-school suspensions? *
12. Do you feel safe at school? *
13. Is there gang activity at your school? *
Family Information
14. If under 18, do your parents or guardians usually know who you are with when you are not at home or at school? *
15. Are one or more of your family members in a gang? *
16. Are one or more of your family members in prison? *
17. Is it important to you family that you finish(ed) high school? *
18. Is it important to your family that you continue your education after high school? *
Think about the people who you hang out with the most, (we don't need to know any names). In the past year, have any of these people:
19. Been suspended from school? *
20. Carried a gun? *
21. Sold drugs? *
22. Stolen or tried to steal a car, motorcycle, ATV, dirt bike, credit cards or another item worth more than $500? *
23. Been arrested? *
24. Are any of these people in a gang or crew? *
These questions are about you.
25. Would you feel safer in your neighborhood if you were part of a gang or crew? *
26. Are you currently in a gang or crew? *
27. If no, have you ever been a member of a gang or crew? *
28. Have you ever heard gunshots in your neighborhood? *
29. Have you ever been arrested? If so, how many times have you been arrested? A *
29a. How old were you the first time you were arrested? *
If you are over 18: Do you have someone in your life who you can talk with about personal problems? (Under 18): Do have at least one adult in your life who you can talk with about personal problems? *
31. Other than coming here, do you participate in other organized activities such as sports teams, volunteering, or other youth programs? *
32. Could you tell me about some of your goals? *
33. Is there anything you’d like to talk more about based on the questions I’ve asked you? *
Would you have preferred to have someone ask you the questions to complete this or on your own?  Why or why not? *
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