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Neighborhood:
Grade:
Type of School:
 

I vote or am planning to register to vote when I turn 18.
True  Somewhat True  Doesn't Apply to Me  Somewhat False   False 
 

I know where I can vote.
True  Somewhat True  Doesn't Apply to Me  Somewhat False   False 
 

I know where I can find a voter registration form.
True  Somewhat True  Doesn't Apply to Me  Somewhat False   False 
 

I have had alcohol poisoning or it is common among my group of friends.
True  Somewhat True  Doesn't Apply to Me  Somewhat False   False 
 

I know where I could buy drugs if I wanted to.
True  Somewhat True  Doesn't Apply to Me  Somewhat False   False 
 

I have been in a car with a driver who has consumed alcohol.
True  Somewhat True  Doesn't Apply to Me  Somewhat False   False 
 

I feel informed about STDS, pregnancy and sex.
True  Somewhat True  Doesn't Apply to Me  Somewhat False   False 
 

I have taken a sexual education course in school.
True  Somewhat True  Doesn't Apply to Me  Somewhat False   False 
 

I know where to get contraception.
True  Somewhat True  Doesn't Apply to Me  Somewhat False   False 
 

I feel safe riding the MBTA.
True  Somewhat True  Doesn't Apply to Me  Somewhat False   False 
 

Gang violence is a big problem in my neighborhood.
True  Somewhat True  Doesn't Apply to Me  Somewhat False   False 
 

I carry a weapon to protect myself or I know someone who does.
True  Somewhat True  Doesn't Apply to Me  Somewhat False   False 
 

What is the one thing you would most like to see changed in Boston? How would you change it?
Is there anything else you would like to see the MYC focus on?