National Youth in Transition Database (NYTD) Youth Outcome Survey Instructions

Check this box if, in the past two years, you or someone else referred you for an alcohol or drug abuse assessment or counseling.

Check this box if, in the past two years, neither you nor anyone else referred you for an alcohol or drug abuse assessment or counseling.

Check this box if you decline to answer whether you or someone else referred you for an alcohol or drug abuse assessment or counseling in the past two years.

Check this box if you gave birth to or fathered any children that were born in the past two years.

Check this box if you did not give birth to or father any children that were born in the past two years.

Check this box if you decline to answer whether you gave birth to or fathered any children that were born in the past two years.

Check this box if you were confined in a jail, prison, correctional facility, or juvenile or community detention facility in the past two years, in connection with allegedly committing a crime.

Check this box if you were not confined in a jail, prison, correctional facility, or juvenile or community detention facility in the past two years, in connection with allegedly committing a crime.

Check this box if you decline to answer whether you were confined in a jail, prison, correctional facility, or juvenile or community detention facility in the past two years, in connection with allegedly committing a crime.

Enter the date the survey was completed.

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. Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you are not currently using a scholarship, grant, stipend, student loan, voucher, or other type of educational financial aid to cover any educational expenses. Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you decline to answer whether you are currently using educational financial aid to cover expenses. Fill only if 'Former Youth in Care' is 'Yes'

The user should check this box if they are currently enrolled in and attending high school, GED classes, post-high school vocational training, or college. Fill only if 'Youth Status' is 'Former Youth in Care'

The user should check this box if they are not currently enrolled in or attending high school, GED classes, post-high school vocational training, or college. Fill only if 'Youth Status' is 'Former Youth in Care'

The user should check this box if they decline to answer whether they are currently enrolled in and attending high school, GED classes, post-high school vocational training, or college. Fill only if 'Youth Status' is 'Former Youth in Care'

Check this box if the individual is currently employed full-time.

Check this box if the individual is not currently employed full-time.

Check this box if the individual declined to answer whether they are currently employed full-time.

Check this box if your highest educational degree or certification received is a high school diploma or GED. Fill only if 'Youth Status' is 'Former Youth in Care'

Check this box if your highest educational degree or certification received is a vocational certificate. Fill only if 'Youth Status' is 'Former Youth in Care'

Check this box if your highest educational degree or certification received is a vocational license. Fill only if 'Youth Status' is 'Former Youth in Care'

Check this box if your highest educational degree or certification received is an Associate's degree (e.g., A.A.). Fill only if 'Youth Status' is 'Former Youth in Care'

Check this box if your highest educational degree or certification received is a Bachelor's degree (e.g., B.A. or B.S.). Fill only if 'Youth Status' is 'Former Youth in Care'

Check this box if your highest educational degree or certification received is a degree higher than a Bachelor's degree (e.g., Master's, Doctorate). Fill only if 'Youth Status' is 'Former Youth in Care'

Check this box if you have not received any of the listed degrees or certifications. Fill only if 'Youth Status' is 'Former Youth in Care'

Check this box if you decline to state your highest educational degree or certification received. Fill only if 'Youth Status' is 'Former Youth in Care'

Check this box if you were homeless at any time in the past two years.

Check this box if you were not homeless at any time in the past two years.

Check this box if you decline to answer whether you were homeless at any time in the past two years.

Check this box if you are currently receiving any sort of housing assistance from the government, such as living in public housing or receiving a housing voucher. Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you are not currently receiving any sort of housing assistance from the government. Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you decline to answer whether you are currently receiving any sort of housing assistance from the government. Fill only if 'Former Youth in Care' is 'Yes'

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'.

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'.

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'.

Check this box if you are currently on Medicaid. Fill only if 'Q19' is 'Yes'.

Check this box if you are currently not on Medicaid. Fill only if 'Q19' is 'Yes'.

Check this box if you decline to answer whether you are currently on Medicaid. Fill only if 'Q19' is 'Yes'.

Check this box if you do not know whether you are currently on Medicaid. Fill only if 'Q19' is 'Yes'.

Check this box if your health insurance includes coverage for medical services. Fill only if 'Yes, I have other health insurance' is 'Yes'.

Check this box if your health insurance does not include coverage for medical services. Fill only if 'Yes, I have other health insurance' is 'Yes'.

Check this box if you decline to answer whether your health insurance includes coverage for medical services. Fill only if 'Yes, I have other health insurance' is 'Yes'.

Check this box if you do not know whether your health insurance includes coverage for medical services. Fill only if 'Yes, I have other health insurance' is 'Yes'.

Check this box if your health insurance includes coverage for mental health services. Fill only if 'Yes, I have other health insurance', 'Yes' is 'Yes' for all.

Check this box if your health insurance does not include coverage for mental health services. Fill only if 'Yes, I have other health insurance', 'Yes' is 'Yes' for all.

Check this box if you decline to answer whether your health insurance includes coverage for mental health services. Fill only if 'Yes, I have other health insurance', 'Yes' is 'Yes' for all.

Check this box if you do not know whether your health insurance includes coverage for mental health services. Fill only if 'Yes, I have other health insurance', 'Yes' is 'Yes' for all.

Check this box if the survey was administered in person at an office.

Check this box if the survey was administered in person at the youth's home.

Check this box if the survey was administered over the phone.

Check this box if the survey was administered via mail or email.

Check this box if the person completed an apprenticeship, internship, or other on-the-job training, either paid or unpaid, in the past year.

Check this box if the person did not complete an apprenticeship, internship, or other on-the-job training, either paid or unpaid, in the past year.

Check this box if the person declined to answer whether they completed an apprenticeship, internship, or other on-the-job training in the past year.

Check this box if you are currently receiving any periodic and/or significant financial resources or support from another source not previously indicated and excluding paid employment. Fill only if 'Former Youth in Care' is 'Yes'

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. Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you decline to answer whether you are receiving periodic and/or significant financial resources or support from another source not previously indicated and excluding paid employment. Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you currently have health insurance other than Medicaid. Fill only if 'Q19' is 'Yes'.

Check this box if you currently do not have any health insurance other than Medicaid. Fill only if 'Q19' is 'Yes'.

Check this box if you decline to answer whether you have health insurance other than Medicaid. Fill only if 'Q19' is 'Yes'.

Check this box if you do not know whether you have health insurance other than Medicaid. Fill only if 'Q19' is 'Yes'.

Check this box if the individual is currently employed part-time.

Check this box if the individual is not currently employed part-time.

Check this box if the individual declined to answer whether they are currently employed part-time.

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.

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.

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.

Check this box if you are currently receiving public food assistance. Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you are not currently receiving public food assistance. Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you decline to answer whether you are currently receiving public food assistance. Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you are currently receiving social security payments (Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), or dependents' payments). Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you are not currently receiving social security payments (Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), or dependents' payments). Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you decline to answer whether you are currently receiving social security payments. Fill only if 'Former Youth in Care' is 'Yes'

Please provide the name of the individual who administered the survey.

Check this box if a Caseworker administered the survey.

Check this box if an NYTD Coordinator administered the survey.

Check this box if someone other than a Caseworker or NYTD Coordinator administered the survey.

Please specify the role of the survey administrator if 'Other' is selected. Fill only if 'Other' is 'Yes'.

Check this box if you are currently receiving ongoing welfare payments from the government to support your basic needs. Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you are currently not receiving ongoing welfare payments from the government to support your basic needs. Fill only if 'Former Youth in Care' is 'Yes'

Check this box if you decline to answer whether you are currently receiving ongoing welfare payments from the government. Fill only if 'Former Youth in Care' is 'Yes'

Enter the full name of the youth.