National Youth in Transition Database (NYTD) Survey Instructions
This form contains 78 fields organized into 24 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Confined in a Detention Facility | ||
| Yes | Checkbox |
Check this box if you have been confined in a jail, prison, correctional facility, or juvenile or community detention facility in connection with allegedly committing a crime.
|
| No | Checkbox |
Check this box if you have not been confined in a jail, prison, correctional facility, or juvenile or community detention facility in connection with allegedly committing a crime.
|
| Declined | Checkbox |
Check this box if you decline to answer whether you have been confined in a jail, prison, correctional facility, or juvenile or community detention facility in connection with allegedly committing a crime.
|
| Currently on Medicaid | ||
| Yes | Checkbox |
Check this box if you are currently on Medicaid. Fill only if 'Q16' is 'Yes'.
|
| No | Checkbox |
Check this box if you are currently not on Medicaid. Fill only if 'Q16' is 'Yes'.
|
| Declined | Checkbox |
Check this box if you decline to answer whether you are currently on Medicaid. Fill only if 'Q16' is 'Yes'.
|
| Don't Know | Checkbox |
Check this box if you do not know whether you are currently on Medicaid. Fill only if 'Q16' is 'Yes'.
|
| Date Survey Completed | ||
| Survey Completion Date | Date |
Enter the date on which the survey was completed.
|
| Educational Financial Aid | ||
| Yes | Checkbox |
Check this box if you are currently using a scholarship, grant, stipend, student loan, voucher, or other type of educational financial aid to cover any educational expenses.
|
| No | Checkbox |
Check this box if you are not currently using any scholarship, grant, stipend, student loan, voucher, or other type of educational financial aid to cover educational expenses.
|
| Declined | Checkbox |
Check this box if you decline to answer whether you are currently using educational financial aid.
|
| Enrollment Status in Education or Training | ||
| Yes | Checkbox |
Check this box if you are currently enrolled in and attending high school, GED classes, post-high school vocational training, or college.
|
| No | Checkbox |
Check this box if you are not currently enrolled in and attending high school, GED classes, post-high school vocational training, or college.
|
| Declined | Checkbox |
Check this box if you decline to answer whether you are currently enrolled in and attending high school, GED classes, post-high school vocational training, or college.
|
| Full-Time Employment Status | ||
| Yes, employed full-time | Checkbox |
Check this box if you are currently employed full-time.
|
| No, not employed full-time | Checkbox |
Check this box if you are not currently employed full-time.
|
| Declined to answer full-time employment | Checkbox |
Check this box if you decline to answer whether you are currently employed full-time.
|
| Given Birth to or Fathered Children | ||
| Yes | Checkbox |
Check this box if you have given birth to or fathered any children that were born.
|
| No | Checkbox |
Check this box if you have not given birth to or fathered any children that were born.
|
| Declined | Checkbox |
Check this box if you decline to answer whether you have given birth to or fathered any children that were born.
|
| Health Insurance Other Than Medicaid | ||
| Yes | Checkbox |
Check this box if you currently have health insurance other than Medicaid.
|
| No | Checkbox |
Check this box if you currently do not have health insurance other than Medicaid.
|
| Declined | Checkbox |
Check this box if you decline to answer whether you currently have health insurance other than Medicaid.
|
| Don't Know | Checkbox |
Check this box if you do not know whether you currently have health insurance other than Medicaid.
|
| Highest Educational Degree or Certification | ||
| Check Box18 | CheckBox | |
| Check Box19 | CheckBox | |
| Check Box20 | CheckBox | |
| Check Box21 | CheckBox | |
| Check Box22 | CheckBox | |
| Check Box23 | CheckBox | |
| Check Box24 | CheckBox | |
| Check Box25 | CheckBox | |
| HOUSING | ||
| Check Box28 | CheckBox | |
| No | Checkbox |
Check this box if you have not been homeless.
|
| Declined | Checkbox |
Check this box if you decline to answer whether you have been homeless.
|
| Married to Child's Other Parent at Time of Birth | ||
| Yes | Checkbox |
Check this box if you were married to the child's other parent at the time each child was born. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Checkbox |
Check this box if you were not married to the child's other parent at the time each child was born. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Declined | Checkbox |
Check this box if you decline to answer whether you were married to the child's other parent at the time each child was born. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Medical Services Coverage | ||
| Yes | Checkbox |
Check this box if your health insurance includes coverage for medical services. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Checkbox |
Check this box if your health insurance does not include coverage for medical services. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Declined | Checkbox |
Check this box if you decline to answer whether your health insurance includes coverage for medical services. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Don't Know | Checkbox |
Check this box if you do not know whether your health insurance includes coverage for medical services. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Mental Health Services Coverage | ||
| Yes | Checkbox |
Check this box if your health insurance includes coverage for mental health services. Fill only if 'Yes', 'Yes' is 'Yes' for all.
Depends on:
Yes, Yes
|
| No | Checkbox |
Check this box if your health insurance does not include coverage for mental health services. Fill only if 'Yes', 'Yes' is 'Yes' for all.
Depends on:
Yes, Yes
|
| Declined | Checkbox |
Check this box if you decline to answer whether your health insurance includes coverage for mental health services. Fill only if 'Yes', 'Yes' is 'Yes' for all.
Depends on:
Yes, Yes
|
| Don't Know | Checkbox |
Check this box if you do not know whether your health insurance includes coverage for mental health services. Fill only if 'Yes', 'Yes' is 'Yes' for all.
Depends on:
Yes, Yes
|
| Method of Survey Administration | ||
| In-Person (Office) | Checkbox |
Check this box if the survey was administered in person at an office location.
|
| In Person (Home) | Checkbox |
Check this box if the survey was administered in person at the youth's home.
|
| Phone | Checkbox |
Check this box if the survey was administered over the phone.
|
| Mail/Email | Checkbox |
Check this box if the survey was administered via mail or email.
|
| On-the-Job Training Completion | ||
| Yes | Checkbox |
Check this box if you completed an apprenticeship, internship, or other on-the-job training in the past year.
|
| No | Checkbox |
Check this box if you did not complete an apprenticeship, internship, or other on-the-job training in the past year.
|
| Declined | Checkbox |
Check this box if you decline to answer whether you completed an apprenticeship, internship, or other on-the-job training in the past year.
|
| Other Financial Resources | ||
| Yes | Checkbox |
Check this box if you are currently receiving periodic and/or significant financial resources or support from another source not previously indicated and excluding paid employment.
|
| No | Checkbox |
Check this box if you are not currently receiving any periodic and/or significant financial resources or support from another source not previously indicated and excluding paid employment.
|
| Declined | Checkbox |
Check this box if you decline to answer whether you are currently receiving any periodic and/or significant financial resources or support from another source.
|
| Part-Time Employment Status | ||
| Yes | Checkbox |
Check this box if the individual is currently employed part-time.
|
| No | Checkbox |
Check this box if the individual is not currently employed part-time.
|
| Declined | Checkbox |
Check this box if the individual declined to answer whether they are currently employed part-time.
|
| PERMANENT RELATIONSHIPS WITH ADULTS | ||
| Yes | Checkbox |
Check this box if there is at least one adult in your life, other than your caseworker, to whom you can go for advice or emotional support.
|
| No | Checkbox |
Check this box if there is no adult in your life, other than your caseworker, to whom you can go for advice or emotional support.
|
| Declined | Checkbox |
Check this box if you decline to answer whether there is at least one adult in your life, other than your caseworker, to whom you can go for advice or emotional support.
|
| Prescription Drugs Coverage | ||
| Yes | Checkbox |
Check this box if your health insurance includes coverage for prescription drugs. Fill only if 'Yes', 'Yes' is 'Yes' for all.
Depends on:
Yes, Yes
|
| No | Checkbox |
Check this box if your health insurance does not include coverage for prescription drugs. Fill only if 'Yes', 'Yes' is 'Yes' for all.
Depends on:
Yes, Yes
|
| Declined | Checkbox |
Check this box if you decline to answer whether your health insurance includes coverage for prescription drugs. Fill only if 'Yes', 'Yes' is 'Yes' for all.
Depends on:
Yes, Yes
|
| Don't Know | Checkbox |
Check this box if you do not know whether your health insurance includes coverage for prescription drugs. Fill only if 'Yes', 'Yes' is 'Yes' for all.
Depends on:
Yes, Yes
|
| Referred for Alcohol or Drug Abuse Assessment or Counseling | ||
| Yes | Checkbox |
Check this box if you have referred yourself or someone else has referred you for an alcohol or drug abuse assessment or counseling.
|
| No | Checkbox |
Check this box if you have not referred yourself and no one else has referred you for an alcohol or drug abuse assessment or counseling.
|
| Declined | Checkbox |
Check this box if you decline to answer whether you have been referred for an alcohol or drug abuse assessment or counseling.
|
| Social Security Payments | ||
| Yes | Checkbox |
Check this box if the youth is currently receiving social security payments (Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), or dependents' payments).
|
| No | Checkbox |
Check this box if the youth is not currently receiving social security payments (Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), or dependents' payments).
|
| Declined | Checkbox |
Check this box if the youth declines to answer whether they are currently receiving social security payments (Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), or dependents' payments).
|
| Survey Administrator | ||
| Survey Administrator Name | Text |
Provide the full name of the individual who administered the survey.
|
| Survey Administrator Role | ||
| Caseworker | Checkbox |
Check this box if the survey administrator was a caseworker.
|
| NYTD Coordinator | Checkbox |
Check this box if the survey administrator was an NYTD Coordinator.
|
| Other | Checkbox |
Check this box if the survey administrator was someone other than a caseworker or an NYTD Coordinator.
|
| Other Survey Administrator Role | Text |
Please provide the role of the survey administrator if it is not Caseworker or NYTD Coordinator. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Youth's Name | ||
| Youth's Name | Text |
Please enter the full name of the youth.
|