Loveland Homeless Youth Point-in-Time Count/Survey Report

- 13 -URBAN PEAK POINT-IN-TIME SURVEYLoveland, ColoradoJune 5 th , 2003This is an anonymous survey. DO NOT put your name anywhere on this paper. We represent a youthorganization in Colorado called Urban Peak and we are trying to determine what information and servicesyoung people in the Loveland area need based on their current living situation. This survey is confidentialand the information will allow Urban Peak to provide you with better services. To collect the mostaccurate data possible, we ask that you only complete this survey once throughout the day.Gender: Male Female Transgender Age: _______Ethnicity: Anglo/White African American Latino/HispanicNative American Asian Pacific Islander Other ____________What is the highest grade in school that you have completed? _________Do you have: High School Diploma GED Certificate Any College CreditsNone of the AboveAre you currently living with your family? Yes No Group/Foster home? Yes NoIf not, where are you living? Squat/Street Couch Surfing Relative Friend(s) MotelShelter Car Other__________Do you have friends or know any young people who are homeless? YesNoIf yes, where do they sleep? Squat/Street Couch Surfing Relative Friend(s) MotelShelter Car Other__________If you are not currently living with your family, how long have you been apart?Less than one month 1-3 months 3-6 months More than six monthsHow long have you lived in the Loveland area?Less than 6 monthsMore than 6 monthsDo you have family living in Loveland area? Yes NoIf yes, who? Biological Parent Foster Parent Adoptive ParentGrandparent(s) Other Relative Other __________________Were you born in the Loveland area? Yes No Other ____________________Copyright 2003 by Urban Peak