IYJ Program Feedback Form- Participant

IYJ Program Feedback Form- Participant
Please have the youth who participated in the Intensive Youth Justice Program complete this form. This form asks for feedback on how the program was administered and on the worker who assisted you.
Name
First NameLast Name
Date Began Program
MonthDayYear
You may estimate and give your best guess.
Date Exited Program
MonthDayYear
You may estimate and give your best guess.
IMPORTANT: Your personal information (i.e. name, phone number, address, etc...) will be kept confidential. General eedback may be shared with program supervisors and/or workers to help improve program services.
1. What were some of the skills that you worked on with the IYJ worker to help you reach your goals for meeting court conditions and achieving placement goals?

2a. Program Feedback - Please rate the following areas.

Rows	Needs Improvement	Somewhat Satisfied	Satisfied	Very Satisfied
Program was customized to help meet individual goals and preferences
Activities and their relationship to goals were explained
Space was given to ask questions and propose your own solutions or ideas in meeting your goals
The structure and purpose of the program were explained
Progress was reviewed in a timely manner

2b. Please write any additional suggestions or comments for improving the program in the space provided below.

3a. IYJ Worker Feedback- Please rate the following areas

Rows	Needs Improvement	Somewhat Satisfied	Satisfied	Very Satisfied
Was the worker available for your program needs?
Was the worker timely in responding to questions or requests?
Was the worker professional in her speech and dress?
Did the worker provide opportunity for collaboration on meeting program goals?
Did the worker supply updates of progress as requested?

3b. Please write any additional suggestions or comments for what you liked or would have liked to see more of from your program worker in the space provided below.
4. What do you think helped the most in making progress towards your goals? (Select all that apply)
Should be Empty: