"Check the Box" MSLYC Youth Initiative
"Check the Box" Youth Initiative is a youth/student driving effort to research how critical resources correlate to the needs for American Indian students enrolled in Arizona Elementary and Secondary Schools. Youth ages 11-24 are encourage to submit personal responses to the following questions.
Tribal Membership
*
Ak-Chin
Cocopah
Colorado River Indian Tribe
Fort McDowell Yavapai Apache
Fort Mohave
Gila River
Havasupai
Hopi
Hualapai
Kaibab
Navajo
Pascua Yaqui
Quenchan
Salt River Indian Community
San Carlos Apache
San Juan Paiute
Tohono O'doham
Tonto Apache
White Mountain Apache
Yavapai Apache
Yavapai Prescott
Other
Age
*
Most recent past school Name
*
Grade
*
5th
6th
7th
8th
9th
10th
11th
12th
High School Graduate
College
Zip Code
*
Number of years living in the greater Arizona area (Includes Phoenix, Mesa, Tempe, Scottsdale, etc.)
*
0-5 Years
6-10 Years
11-16 Years
17-24 Years
Other
Number of years living on the reservation.
*
0-5 Years
6-10 Years
11-16 Years
17-24 Years
Other
Name resources (places) and/or title of person (counselor, coach, Pastor, etc.) that can help you when you have difficulties with your school work?
*
How can you be supported in your education efforts in high school or going to college?
*
How many Native American youth groups or programs are you involved in? (Includes Clubs, Dance, Poetry, Reading, Art, Church,) etc.
*
None
1-3
4+
What do you think are major problems that are facing native youth today?
*
Next Section - Check the Scale
Rank the subjects from the easiest to the most difficult (1 being the Easiest, 5 Being the Most Difficult), based on your ability to complete the assignments.
Math
*
1
2
3
4
5
Easy
Difficult
1 is Easy, 5 is Difficult
Reading
*
1
2
3
4
5
Easy
Difficult
1 is Easy, 5 is Difficult
Science
*
1
2
3
4
5
Easy
Difficult
1 is Easy, 5 is Difficult
Writing
*
1
2
3
4
5
Easy
Difficult
1 is Easy, 5 is Difficult
Does your school offer Native American studies class (Choose one)
Yes
No
Don't Know
Do you see Native American culture represented in your school? (Choose one)
Yes
No
Don't Know
If yes, how do you see culture represented in your school?
Can you speak your traditional language? (Choose one)
*
Yes
No
If yes, what is your traditional language?
Is your traditional language spoken at home?
*
Yes
No
How do you see yourself fitting into your tribal community?
*
Do you participate in community events or programs?
Yes
No
Don't Know
If so, which community events or programs do you participate in?
What do you wish you could see more of in your reservation?
*
Can you identify places you can go to for help with personal problems or family problems?
Yes
No
Don't Know
Thank You
We would like to continue exploring what can be done to support Native youth. If you would like to participate in a group discussion, please leave your contact information below.
Name
First Name
Last Name
E-mail
Phone Number
-
Area Code
Phone Number
SUBMIT
Should be Empty: