Transition Youth Survey
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(Optional)
Consumer’s name (Name of the child) _______________________________
Date:__________
TELL ME HOW YOU FEEL Please help us by answering these simple questions. You do not have to do this survey if you do not want to. Read the question and circle the face that shows how you feel. There are no wrong answers. Circle YES.
if your answer is
If you do not know what to answer circle
.
Yes
I don’t know
Circle no.
if your answer is
No
1. the team members were helpful.
N/A
2. My team members were nice.
N/A
3. My team members wanted to help me.
N/A
4. I saw a team member when I needed to.
N/A
5. My team knew how to help me.
N/A
6. Our time together was fun.
N/A
7. I am happier now.
N/A
8. My family is happier now.
N/A
I Would you like to say ________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ You Did Great!!!!......................Thank You!!!
QI102.7—Transition Youth Satisfaction Survey
Est. Mar 2008
Consumer’s name (Name of the child) _______________________________
Date:__________
TELL ME HOW YOU FEEL Please help us by answering these simple questions. You do not have to do this survey if you do not want to. Read the question and circle the face that shows how you feel. There are no wrong answers. Circle YES.
if your answer is
If you do not know what to answer circle
.
Yes
I don’t know
Circle no.
if your answer is
No
1. the team members were helpful.
N/A
2. My team members were nice.
N/A
3. My team members wanted to help me.
N/A
4. I saw a team member when I needed to.
N/A
5. My team knew how to help me.
N/A
6. Our time together was fun.
N/A
7. I am happier now.
N/A
8. My family is happier now.
N/A
I Would you like to say ________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ You Did Great!!!!......................Thank You!!!
QI102.7—Transition Youth Satisfaction Survey
Est. Mar 2008
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