Hebron & Zoneton Youth Services Center
Student Survey 2019-2020

In planning programs to best serve you, the YSC needs your input.  Please answer all questions to the best of your ability.  All answers will be kept confidential and email addresses are not collected automatically.


I attend: *
I am in ... *
Required
Who do you currently live with? *
Required
Which of the following do you think that YOU personally know need help with? (Check all that apply) *
Required
What do you think are the top 3 HEALTH issues that interfere with student learning? *
Required
Do you or your family need assistance or information on Dental, vision or Health Services? *
Do you or your family need assistance or information on managing anger? *
Do you or your family need assistance or information on suicidal thoughts for yourself or concern for a friend? *
Do you need to talk to someone about private issues? *
Do you or your family need assistance with clothing? *
Do you or your family need assistance with food at home? *
Do you or your family need assistance with utilities (water, electric, gas)? *
Have you ever had thoughts of suicide? *
Have you ever intentionally hurt yourself? (ex. cutting, hitting, biting yourself, etc) *
Are you currently or have you ever been in counseling/therapy? *
Do you feel pressure from others to take drugs? *
Have you used a Vape in the last 30 days? *
Have you used tobacco products in the last 30 days? *
Have you drank alcohol in the last 30 days? *
Have you used marijuana products in the last 30 days? *
Do you or have you ever used prescription drugs that were NOT yours? *
Have you used other illegal drugs in the last 30 days? *
Do you need to talk to someone about the death of a friend or family member? *
What do you consider to be the biggest problem at school? *
Do you feel safe at school? *
Have you been "bullied" or "harassed" at school in the last 30 days? *
Would you like to see more activities after school or in the summer (other than sports) offered at your school? If so, what do you feel is most needed? *
I would like my future career to be: (examples-teacher, doctor, mechanic) *
What do you feel would help you decide your future career or college plans? *
Do you know where the Youth Services Center is? *
Do you know what the Youth Services Center does? *
Name (optional)
If you have questions or need assistance with any of these issues, please see the school counselor or contact the Youth Services Center Coordinator, Pamela Herm at 502-869-4212(Hebron)/502-869-4412(Zoneton) or email pamela.herm@bullitt.kyschools.us
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