Juvenile delinquency | QuestionPro

Have you ever witnessed a crime of any type? Ex. Stealing, Rape, murder, etc.

Yes

No

Have you or anyone that know every been a victim at the hand of a juvenile offender?

Yes

No

Have you ever committed a crime as defined in the examples in question 1?

Yes

No

Has anyone in your family ever been to jail or prison?

Yes

No

If so, who_____________________

Do you live with _______________

How many people live in your home?

Less than 3

4 to 6

6 to 8

greater than 8

Are your parent(s)/gaurdian employed?

Yes

No

Has anyone in your immediate family ever been diagnosed with a mental illnes of any kind? (ex: ADHD,ADD,Schizophrenia,Dyslexia)

Yes

No

If so, who:__________________

Do you have a family history of any of the following(select all that apply)?