This survey is for ages 13-17 only. If you are over the age of 17, please fill out our Well-being Survey. Please note, due to privacy laws we cannot accept surveys from individuals under the age of 13.


For the first 17 questions, select the answer that best applies to you. There are no right or wrong answers.
 

Please Imagine a ladder with steps numbered from zero at the bottom to ten at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you.

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* 1. Indicate where on the ladder you feel you personally stand right now.

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* 2. On which step do you think you will stand about five years from now?

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* 3. If something interests me, I try to learn more about it.

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* 4. My life will make a difference in the world.

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* 5. I feel I am an important part of my community.

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* 6. I like coming up with new ways to solve problems.

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* 7. If I set goals, I take action to reach them.

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* 8. Setbacks don’t discourage me.

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* 9. I have a friend who I can count on to be there for me.

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* 10. I have a family member who I can count on to be there for me.

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* 11. I have an adult in my life who cares about my future.

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* 12. I have at least one teacher who makes me excited about the future.

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* 13. In general, how would you rate your emotional health?

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* 14. In general, how would you rate your physical health?

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* 15. How likely are you to live in the Fox Cities as an adult?

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* 16. What do you think positively contributes most to our community well-being?

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* 17. What do you think hinders our community’s potential well-being?

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* 18. What is your age, in years?

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* 19. What is your gender?

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* 20. Which one or more of the following would you say is your race/ethnicity? (select all that apply)

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* 21. If you are currently in school, in what grade are you now?

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* 22. If you are not currently in school, what is the highest level of education you have completed?

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* 23. In what community do you live? (e.g., city, town, village)

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