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* Have you been asked for input into decisions about your care? 

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* I am able to participate with the following while I have been in foster care:

  Yes No This does not apply to me
My regular schooling
Activities outside of school (examples would be sports, religious services, afterschool clubs)
My hygiene needs (examples would be preferred hair or shaving products, skincare or cosmetic products)
Visits to my family doctor or dentist
Spending time with my friends 
Getting to talk with my birth family members 
Celebrating special days (examples might be a birthday or holiday)

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* Are you treated with kindness in your foster home?

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* In my foster home:

  Yes No This does not apply to me
I feel safe
I am comfortable talking to my foster parent about my thoughts and feelings
I can be alone if I need space
My background is respected (such as religious beliefs, customs and traditions, language)

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* Is there anything you would like to change in your foster home?

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* Is there anything you would like to do during family visits that you haven't had a chance to do?

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* Is there anything you would like to share about your experience in foster care?

T