RHYS RHYS Enter What is your HFY Number? How do you identify your gender?*AgenderFemaleGender FluidMalePangenderPrefer not to sayQuestioningTransgenderWhat is your age?* 12-15 15-18 18-21 How do you identify your race?* Asian Black/African American Hispanic Multiracial Native American Native Hawaiian/Pacific Islander White/Caucasian Other Where did you stay last night?* At the home of parent, guardian or foster parent At the home of a friend- indoors, on a couch or in place meant for regular sleeping At the home of a relative - indoors, on a couch or in place meant for regular sleeping Stayed outdoors or in a public place, like a park, the street, a campground, a train or bus station, etc. Stayed at the home of their partner, boyfriend, or girlfriend; Stayed at a youth or adult shelter Stayed at a transitional living program Stayed at a hotel/motel paid for by a government program or nonprofit organization Stayed in an abandoned building or squatted Stayed in a car, train, bus, or RV; How long have you been staying there?* Days Weeks Months Years How long have you been without a home, or a regular place to stay?* Days Weeks Months Years How often have you gone without food?*Skipped a meal here & thereWent an entire day with out foodCan't remember the last time I ateWhat town were you living in before coming to our shelter?* What School/School District do you attend?* Thinking about the past 3 years, how many different times have you been without a home, or a regular place to stay?* 0 1-3 4-10 11-50 What were the reason(s) for your change in living situation?* Ran Away/Kicked out from your family home Ran away/kicked out from a group home or foster home Violence at home between family members Difference with parents about religious beliefs Made a life or identity change & was told to leave home Left home because of some other reason Have you ever been in foster care?*YesNoIn the past 30 days, have you used/taken drugs?*YesNoIn the past 30 days, have you drank alcohol?YesNoI often experience feelings of sadness, depression or anxiety. Disagree Neither Disagree or Agree Agree I have been asked to participate in sexual activities in exchange for money, a place to stay or material items Disagree Neither Disagree or Agree Agree Do you know of any other homeless youth? Yes No If you answered yes, where are they located? Share more about your story with us:Which social media handle do you use to communicate?* Facebook Instagram Snap Chat WhatsApp Twitter GroupMe kik Facebook Messenger
