2007-2008 Approved Additional Retrospective Questions – OPTIONAL
Based upon suggestions from Grantees provided in grant applications submitted for PY 2007-2008, the following items have been
approved as OPTIONAL ADDITIONAL QUESTIONS that may be used for the retrospective surveys. These items DO NOT
REPLACE THE REQUIRED QUESTIONS on the retrospective surveys. You may choose to add these to your participant survey if
you determine that they will assess other program objectives you have that are not assessed with the required survey questions. You
may select from the questions; you can use any or all questions. If you choose to add items from the applicable list to your survey,
copy and paste the item(s) to the end of your survey or put them on a second page attached to your survey.
Respite Care Programs
21. My knowledge of how to keep my child with special health care needs safe during
an emergency or disaster.
22. My relationship with my spouse or partner.
23. My ability to recognize the need for a break from my stressful daily routine.
24. My knowledge of the signs and symptoms of depression.
25. My knowledge of recreational activities available in my area.
26. My knowledge of how to use internet resources to perform searches for
Child-Focused Programs (6th grade and above)
26. My ability to identify gang behavior (dress and symbols).
27. My ability to list the dangers of gang involvement.
28. My knowledge of how to avoid gang involvement.
29. My knowledge of gun safety.
30. My knowledge of the severity of punishment for gun-related crimes.
31. My relationship with my parents/caregiver.
32. My ability to effectively communicate with my parents/caregiver.
33. My ability to feel positive about myself.
34. My ability to fe