Youth Participation Form

Your Name

*

Your Age

*

City

*

County

*

Tell us some things that are going well with you?

How is it going where you live?

What grade are you in? How are your grades?

Is there anything you need help with?

Do you participate in any extracurricular activities? Extra Curricular Activities (sports, music, art, etc.)

What are your plans for the future?

Do you have any medical or dental needs that you want the Board/Court to know about?

Have you seen your case manager in the last 30 days?

Yes
No

Where did you and your casa manager last meet?

Do you know how to contact your Court Appointed Attorney/GAL?

Yes
No

When and where did you and your attorney last meet?

Are you visiting with your family?

Is there anyone you are not seeing or having contact with (in person, letter, and phone) that you would like to?

Anything else you would like to tell the Board?

FOR 14 YEARS AND OLDER

Are you on track to graduate? How many credits have you earned?

Is anyone helping you explore future career/professional plans?

Has anyone talked to you about college/vocational training and the financial resources that are available to you?

What preparation are receiving to live on your own after age 18?

Are you employed? If so, approximate weekly hours?

Have you and your case manager discussed your case plan? Do you understand what you need to do to live independently?