AMITY HS SURVEY for United Teen Connection 203 789 8336

1. “A simple program of educating teens to help themselves and others before a crisis develops” Mailing address: United Teen Connection, Inc. 514 Foxon Blvd., PB 465 New Haven, Ct 06513 • United Teen Connection, Inc. 203-789-8336 • TEEN TO TEEN HELPLINE S U R V E Y • AGE:10__ 11__ 12__13__ 14__ 15 __ 16 __ 17 __ 18__ 19 __ 20 __ 22__ Other __ • GRADE 6TH __ 7TH __ 8TH __ 9TH __ 10TH __ 11TH __ 12 __ COLLEGE: ___________ • NAME OF SCHOOL _______________ NAME OF YOUTH GROUP _____________ • BEST SUBJECT __________________ WORST SUBECT ____________________ • Did you ever hear about United Teen Connection – Primary Prevention Teen to Teen YES __ NO __ If YES where did you hear about the program? • Friend __ Parent __ School __ Bus __ Radio __ Public Access TV __ Internet __ Teen Life conference __ Youth Health Fair __ • Community Program ___OTHER____________________________________ • When you are facing a problem or need support, where do you go for support/help/understanding? Friend __ Parent/Guardian __ School teacher __ School Nurse __ Neighbor __ Church __ School Guidance Counselor __ • Other ________________________________________________________ • Do you think that there is a need for a service such as Teens Helping Teens TEEN HELPLINE and Training? YES __ NO __ • If no why is there not a need _____________________________________ • 4. Would you consider calling “Teen to Teen Helpline 203-789-8336” if you needed someone to talk to? (confidentially, anonymously and with no caller ID or use of *69) • YES __ NO __ • PLEASE TURN PAGE OVER AND COMPLETE QUESTIONS (THANK YOU)

2. During what hours do you think it is important for the TEEN TO TEEN HELPLINE 203-789-8336 be open? • __ 3:00pm-6:00pm __3:00pm-8:00pm __ 6:00pm-8:00pm _ 5:00pm-8:00pm • Other _______________ • What kinds of problems or concerns would make you or a friend reach out for information/help/support? • academics __ boyfriend/girlfriend relationships __ birth control __ health __ loss of a friend/relative __ physical abuse __ loneliness __ legal issues __ job issues __ • sexual abuse __ dating violence __ sexual identity __ depression __ • hurting self __ hurting others__ running away __ family concerns __ • OTHER ____________________________________________________________ • 7. Have you ever called 203-789-8336? YES __ NO __ IF YES was services excellent __ good__ average__ • below average __ poor __ OTHER ____________________________________ • Would you tell a friend who needs someone to talk to about our 203-789-8336 teen helpline? YES __ NO __ • Why?________________________________________________________________ • Would you like to receive school Community Service Volunteer Credit Hours for participating in Training/ Answering Phone? YES __ NO__ • Would you use out teen to teen services or tell a friend about us? YES__ NO__ • 11. In what capacity would you use our services? • As a TEEN Calling in YES__ NO __ • As a TEEN in Training for helpline YES__ NO __ • BOTH (Teen in Training and Caller) YES__ NO__ • Would you like more information? YES __ NO__ If YES how can we get in contact PLEASE PRINT • Phone: ________________________ email _______________________ School counselor ________________ • Name: _________________________ Address _____________________ • Other __________________________ • Do you think this PROGRAM is worth funding? YES__ NO__ WHY?______________________________________________________________ • THANK YOU FOR ANSWERING THIS SURVEY • Please call us if you need further information on services offered 203-789-8336 • http://groups.yahoo.com/group/unitedteenconnectionnhct or united.teen.connection.n.h.ct@juno.com or henningersh@aol.com • SH: 1 Survey 6-16-2009