This survey uses a trial version of the Alchemer platform and the user’s identity is not verified.
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CAFS IRP

Page One

1. What gender are you? *This question is required.
2. Are you an adolescent? (Between the ages of 12 and 18) If no thank you for your contribution. *This question is required.
3. What is your age? *This question is required.
4. What is your family structure?

Nuclear: a family where a husband and wife live together with their children who are either biological, adopted or fostered.

Adoptive: a legal arrangement that transfers parental rights from your biological parent to your adopting parents.

Same-sex: a family with or without children with parents of the same sex.

Blended: a family with a combination of biological and step-children living with parents.

Communal: a family that consists of other family types joining together, usually this is when different people who are not necessarily related are
living together

De facto: a family that consists of two adults that are not married, can have children involved.

Extended: a family that consists of different generations, ie grandparents, parents, children, uncles, aunts of cousins.

Foster: a temporary family where children live with an un-biological guardian.

Sole-parent: a family that consists of only one parent either female or male with one or more children. *This question is required.
5. How many children are in your family? (including yourself) *This question is required.
6. Are you healthy? *This question is required.
7. How would you rate your overall health? (1 being the worst and 10 being the best) *This question is required.
8. Do your parents have a stable job/income? *This question is required.
9. Do your parents worry about money? *This question is required.
10. How would you classify your family's economic status? *This question is required.
11. Does your family have access to adequate health care? *This question is required.
12. Do you have access to adequate education? *This question is required.
13. Do you have access to adequate healthy food? *This question is required.
14. Do you have a healthy diet? *This question is required.
15. Do you have access to adequate and clean water? *This question is required.
16. Do you get adequate sleep? (9 to 10 hours per night) *This question is required.
17. Do you feel safe and comfortable at home? *This question is required.
18. Does your life follow routine? *This question is required.
19. Do you have stability in your life? *This question is required.
20. Do you feel you are reaching your maximum potential? *This question is required.
22. How would you rate your physical wellbeing? (1 being the worst and 10 being the best) *This question is required.
24. Do you adjust well to change? *This question is required.
26. How would you rate your self esteem? (1 being the worst and 10 being the best) *This question is required.
27. Are you a confident person? *This question is required.
28. Do you feel loved? *This question is required.
29. Do you have goals in life? (either short term or long term) *This question is required.
30. Are you an independent person? *This question is required.
31. How would you rate your emotional wellbeing? (1 being the worst and 10 being the best) *This question is required.
33. Do you have a good relationship with your friends? *This question is required.
34. How would you rate your relationship with your friends? (1 being the worst and 10 being the best) *This question is required.
36. Do you have a good relationship with your family? *This question is required.
37. How would you rate your relationship with your family? (1 being the worst and 10 being the best) *This question is required.
39. Do you feel like you belong? *This question is required.
40. Do others respect you? *This question is required.
41. Do you communicate effectively? *This question is required.
43. How would you rate your social wellbeing? (1 being the worst and 10 being the best) *This question is required.
45. Do you have your own strict morals? *This question is required.
46. Do you follow a religion? *This question is required.
47. Do you have your own values? *This question is required.
48. How would you rate your spiritual wellbeing? (1 being the worst and 10 being the best) *This question is required.
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