Youth Residential Care Survey Form
Please share your honest feedback about your experience in our residential care program. Your responses are confidential and will help us improve our services.
How long have you been in this residential care program?
*
Please Select
Less than 1 month
1–3 months
4–6 months
7–12 months
More than 1 year
How safe do you feel living here?
*
1
2
3
4
5
How would you rate your relationship with the staff?
*
1
2
3
4
5
Please indicate how much you agree with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel supported by the staff.
1
2
3
4
5
I have opportunities to participate in activities.
6
7
8
9
10
I am treated with respect by everyone here.
11
12
13
14
15
Which activities do you participate in regularly? (Select all that apply)
Sports or exercise
Art or music
Group outings
Life skills workshops
Other
How satisfied are you with the meals provided?
*
Very Unsatisfied
1
2
3
4
Very Satisfied
5
1 is Very Unsatisfied, 5 is Very Satisfied
Do you have someone you can talk to when you need support?
*
Yes
No
Not sure
How comfortable do you feel in your room or living space?
*
1
2
3
4
5
What is one thing you would like to see improved in the residential care program?
Any additional comments or suggestions?
Submit Survey
Should be Empty: