Youth VIBE Afterschool Assessment - Mohamed School


A red asterisk (*) indicates required questions.

  1. Please indicate your Gender.  *


  1. What is your race/ethnicity? (Please choose only one)   *


  1. What is your Grade Level?  *


  1. Which answer best decribes your living situation?  *


  1. On average, how often do you attend Youth VIBE?  *


  1. What concerns do you have during the after school hours?*
    Mindless activities, laziness: TV, video games
    Getting into trouble
    Unstructured, unguided time
    Drugs and alcohol
    Gangs, crime, violence
    Boredom
    Dangerous time of day
    Teen sex
    Peer pressure
    Being alone
    Not receiving help with your homework
    Other
    None


  1. How concerned are you that you are unsupervised after school with too much unstructured time.  *


  1. Afterschool programs are an absolute necessity for my community.  *


  1. Participating in the Youth VIBE program has helped me to complete my school work successfully.   *


  1. Participating in the Youth VIBE program has helped improve my grades in subject areas they struggled with prior to the tutoring.   *


  1. The Youth VIBE enrichment program has provided a place for on me to go after school where I feel a sense of belonging (i.e. positive relationship with adults involved, feel welcome and safe while at the program).   *


  1. By participating in the Youth VIBE enrichment program I have been provided with opportunities to learn new skills (i.e. learn new skills, be creative and share what they have learned with others).   *


  1. Participating in the Youth VIBE enrichment program has helped me develop more independence (i.e. opportunities to choose and plan activities in the program).   *


  1. Participating in the Youth VIBE program has had a positive impact on my desire to attend school.   *


  1. The Youth VIBE enrichment program has allowed me to participate in service to others (i.e. community service projects, helping others in the program).   *


  1. I ask for help when I need it.  *


  1. I pay attention when others talk.  *


  1. I tell others how I feel.  *


  1. I return what I borrow.  *


  1. Who has talked to you about your future, such as: getting a job, job training, college, etc.? Please check all that apply.*
    Family Member(s)
    Friends/People in the community (clubs, neighbors, etc.)
    Organization (Boys & Girls Club, Salvation Army, United Way, ect.


  1. Do you have an Individual Education Plan (IEP) or 504 Plan?*
    Yes
    No


  1. Do you participate in your Individual Education Plan (IEP) or 504 Plan?*
    Yes
    No


  1. Do you know who to call if you have a medical emergency?*
    Yes
    No


  1. Do you have a phone to use in case of an emergency?*
    Yes
    No


  1. Do you have the phone numbers of family and friends to call in case of an emergency?*
    Yes
    No


  1. Do you know where the closest hospital is?*
    Yes
    No


  1. Which would be the most helpful for your future?*
    Job Training
    Getting a job
    College education
    Getting your Driver’s license
    Community recreation
    Having health insurance