F.22.13.012 G4C Student Questionnaire_V3_Sept 2018

• Student Name

• Conducted on

  Date

Student Information

• Name:

• Date:

  Date

• Address:

• Telephone No:

• Email Address:

Who do you see for life , School or Support?

Organisation

• Organisation Name:

Who do you live with and what do they do?

• Person I live with

Person

• Relationship to you:

• Occupation

How are you going in life?

• I like who I am

  Yes

  Sort of/Sometimes

  No

• I'm the type of person who can get very angry and lose my temper

  Yes

  Sort of/Sometimes

  No

• I can normally bounce back when things aren't good

  Yes

  Sort of/Sometimes

  No

• I've been kicked out of home in the last six months

  Yes

  Sort of/Sometimes

  No

• Instead of worrying about things I try and get on with it

  Yes

  Sort of/Sometimes

  No

• I have been in trouble with the Police in the last six months

  Yes

  Sort of/Sometimes

  No

• I use drugs/alcohol

  Yes

  Sort of/Sometimes

  No

Achievements

• My biggest achievement in the past months was:

Strenghts

• My strengths are:

Weaknesses

• My weaknesses are:

Future goals

• My future goals are:

• Some of the challenges I might face in achieving my goals are:

Study

• Are you currently studying?

  Yes

  No

• I am going well at school

  Yes

  Sort of/Sometimes

  No

• In the past I have been suspended from school

  Yes

  Sort of/Sometimes

  No

• I attend school regularly

  Yes

  Sort of/Sometimes

  No

• I am enjoying my time at school

  Yes

  Sort of/Sometimes

  No

• I complete my work on time

  Yes

  Sort of/Sometimes

  No

• I have thought about leaving school

  Yes

  Sort of/Sometimes

  No

• I can get to and home from school easily

  Yes

  Sort of/Sometimes

  No

• I have at least one good friend at school

  Yes

  Sort of/Sometimes

  No

• I usually do as I am told when asked by teachers

  Yes

  Sort of/Sometimes

  No

Work

• Are you currently working?

  Yes

  No

• I am enjoying my job

  Yes

  Sort of/Sometimes

  No

• I have been told off at work

  Yes

  Sort of/Sometimes

  No

• I turn up to work on time

  Yes

  Sort of/Sometimes

  No

• I have thought about leaving my job

  Yes

  Sort of/Sometimes

  No

• I can get to and home from work easily

  Yes

  Sort of/Sometimes

  No

• I have learnt new skills at work

  Yes

  Sort of/Sometimes

  No

• I get along with most of the people I work with

  Yes

  Sort of/Sometimes

  No

• I easily remember the instructions given to me at work

  Yes

  Sort of/Sometimes

  No

• I like my manager(s)

  Yes

  Sort of/Sometimes

  No

Transport

• Someone I live with has a car

  Yes

  Sort of/Sometimes

  No

• If I got a job, I would be able to get to and from work

  Yes

  Sort of/Sometimes

  No

• There is public transport nearby, if I need to use it for work or study

  Yes

  Sort of/Sometimes

  No

• Would you be willing to catch public transport for work or study

  Yes

  Sort of/Sometimes

  No

• If you are 16 years or over, do you have your Learner's Permit (L's)

  Yes

  Sort of/Sometimes

  No

• Do you have someone that can help you with your hours for your Learner's Permit (L's)

  Yes

  Sort of/Sometimes

  No

• If you are 18 years or over, do you have your Probationary Licence (P's)

  Yes

  Sort of/Sometimes

  No

• If you are 18 years or over, do you have access to a car you can drive

  Yes

  Sort of/Sometimes

  No