Youth Civic Health Survey
The YMCA Youth Civic Health Survey is inspired by the National Conference on Citizenship's (NCoC)
Civic Health Index
, which utilizes indicators of civic health collected by the U.S. Census Bureau and Bureau of Labor Statistics as part of the Civic Engagement and Volunteerism Supplement of the
Current Population Survey (CPS)
.
Survey Agreement
By completing this survey, you consent to sharing your responses with the YMCA of the USA (The Y). No personal or contact information will be collected beyond demographic data, and all survey responses are anonymous.
Survey Agreement
I agree to participate
School Year
Please select...
2022-2023
Demographic Questions
Age
Please select...
11
12
13
14
15
16
17
18
19
20
Grade
Please select...
6
7
8
9
10
11
12
Gender
Please select...
Male
Female
Gender Non-Conforming
Gender Not Listed
Home Zip Code
Community Type
Please select...
Rural
Urban
Suburban
Race/Ethnicity
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino/a
Native Hawaiian or Other Pacific Islander
White/Caucasian
You may choose one or more, however many apply to you.
Which of the following Asian groups are you?
Please select...
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Which of the following Native Hawaiian or Other Pacific Islander groups are
you?
Please select...
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
Which group do you most closely identify
with?
Please select...
Mexican
Mexican American
Chicano
Puerto Rican
Cuban
Cuban-American
Other Spanish, Hispanic, or Latino group
Participant Type
If your school is not listed after selecting your state, your school's teacher/advisor has not yet completed the YMCA Civic Health Champion
Certification Form
. Please email
jamie@ymcayag.org
with any questions.
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alabama School
Please select...
Choice A
Choice B
Choice C
Alaska School
Please select...
Choice A
Choice B
Choice C
Arizona School
Please select...
Paradise Honors High School
Arkansas School
Please select...
Choice A
Choice B
Choice C
California School
Please select...
Choice A
Choice B
Choice C
Colorado School
Please select...
Choice A
Choice B
Choice C
Connecticut School
Please select...
Choice A
Choice B
Choice C
Delaware School
Please select...
Choice A
Choice B
Choice C
District of Columbia School
Please select...
School Without Walls
Florida School
Please select...
Choice A
Choice B
Choice C
Georgia School
Please select...
Choice A
Choice B
Choice C
Hawaii School
Please select...
Choice A
Choice B
Choice C
Idaho School
Please select...
Choice A
Choice B
Choice C
Illinois School
Please select...
Choice A
Choice B
Choice C
Indiana School
Please select...
Choice A
Choice B
Choice C
Iowa School
Please select...
Choice A
Choice B
Choice C
Kansas School
Please select...
Choice A
Choice B
Choice C
Kentucky School
Please select...
Choice A
Choice B
Choice C
Louisiana School
Please select...
Choice A
Choice B
Choice C
Maine School
Please select...
Gorham High School
Maine Central Institute
Maryland School
Please select...
Choice A
Choice B
Choice C
Massachusetts School
Please select...
Choice A
Choice B
Choice C
Michigan School
Please select...
Airport High School
Beal City Schools
Bronson Jr/Sr High School
Cadillac High School
Caro High School
Cass Technical High School
Chandler Park Academy High School
Cheboygan High School
Clarenceville High School
Cody High School
Coldwater High School
Crockett Midtown High School of Science and Medicine
Dexter High School
Eaton Rapids High School
Elk Rapids High School
Everett High School
Forest Hills Eastern High School
Fruitport High School
Gladstone Area Schools
Harbor Springs High School
Hastings High School
Holland High School
Interlochen Arts Academy
L'Anse Area Schools
Loy Norrix High School
Manistee Middle/High School
Marist Academy
Marshall High School
Mason Consolidated High School (Erie)
Mason High School
Mill Creek Middle School
Mio AuSable High School
Munising Middle/High School
Notre Dame Preparatory School
Novi High School
Onsted High School
Petoskey High School
Petoskey Middle School
Portage Northern High School
Reading High School
Renaissance High School
Rochester Adams High School
Saginaw Heritage High School
Sturgis High School
Superior Central High School
Superior Central Middle School
Union City High School
Vassar Middle & High School
Wayland Union High School
West Side Academy
White Pigeon Jr/Sr High School
Minnesota School
Please select...
Choice A
Choice B
Choice C
Mississippi School
Please select...
Choice A
Choice B
Choice C
Missouri School
Please select...
Choice A
Choice B
Choice C
Montana School
Please select...
Choice A
Choice B
Choice C
Nebraska School
Please select...
Choice A
Choice B
Choice C
Nevada School
Please select...
Choice A
Choice B
Choice C
New Hampshire School
Please select...
Choice A
Choice B
Choice C
New Jersey School
Please select...
Choice A
Choice B
Choice C
New Mexico School
Please select...
Albuquerque Academy
Albuquerque High School
Albuquerque Institute for Math & Science
Cibola High School
Cottonwood Classical Preparatory School
East Mountain High School
Moriarty High School
Santa Fe High School
West Mesa High School
New York School
Please select...
Choice A
Choice B
Choice C
North Carolina School
Please select...
Choice A
Choice B
Choice C
North Dakota School
Please select...
Choice A
Choice B
Choice C
Ohio School
Please select...
Choice A
Choice B
Choice C
Oklahoma School
Please select...
Choice A
Choice B
Choice C
Oregon School
Please select...
Choice A
Choice B
Choice C
Pennsylvania School
Please select...
Choice A
Choice B
Choice C
Rhode Island School
Please select...
Choice A
Choice B
Choice C
South Carolina School
Please select...
Choice A
Choice B
Choice C
South Dakota School
Please select...
Choice A
Choice B
Choice C
Tennessee School
Please select...
Choice A
Choice B
Choice C
Texas School
Please select...
Choice A
Choice B
Choice C
Utah School
Please select...
Choice A
Choice B
Choice C
Vermont School
Please select...
Choice A
Choice B
Choice C
Virginia School
Please select...
Choice A
Choice B
Choice C
Washington School
Please select...
Challenger High School
Garrison Middle School
Kamiak High School
Pioneer Middle School
Skyline High School
Walla Walla High School
West Virginia School
Please select...
Choice A
Choice B
Choice C
Wisconsin School
Please select...
Choice A
Choice B
Choice C
Wyoming School
Please select...
Choice A
Choice B
Choice C
Youth and Government Participation
Please select...
Yes
No
Do you participate in YMCA Youth and Government?
Survey Questions
Please respond to each of the Youth Civic Health Survey questions below. If you have any additional thoughts you'd like to offer on the civic health of your school or community, you can share them at the end of the survey:
Talking to and Spending Time with Family and Friends
In the past 12 months, how often did you talk to or spend time with friends and family?
1 - Basically every day
2 - A few times a week
3 - A few times a month
4 - Once a month
5 - Less than once a month
6 - Not at all
Discussing Various Issues with Family and Friends
In the past 12 months, how often did you discuss political, societal, or local issues with friends or family?
1 - Basically every day
2 - A few times a week
3 - A few times a month
4 - Once a month
5 - Less than once a month
6 - Not at all
Talking to and Spending Time with Neighbors
In the past 12 months, how often did you have a conversation or spend time with your neighbors?
1 - Basically every day
2 - A few times a week
3 - A few times a month
4 - Once a month
5 - Less than once a month
6 - Not at all
Discussing Various Issues with Neighbors
In the past 12 months, how often did you discuss political, societal, or local issues with your neighbors?
1 - Basically every day
2 - A few times a week
3 - A few times a month
4 - Once a month
5 - Less than once a month
6 - Not at all
Doing Favors for Neighbors
In the past 12 months, how often did you/your household and your neighbors do favors for each other such as lawn/property maintenance, house sitting, babysitting, lending tools, and other things to help each other.
1 - Basically every day
2 - A few times a week
3 - A few times a month
4 - Once a month
5 - Less than once a month
6 - Not at all
Doing Something Positive for the Neighborhood
In the past 12 months, did you get together with other people from your neighborhood to do something positive for your neighborhood or the community?
Yes
No
Interacting with Different Racial, Ethnic, or Cultural Backgrounds
In the past 12 months, how often did you talk to or spend time with people from a
racial, ethnic, or cultural background that is different than yours? This may have been
in person, over the phone, or through the internet or social media.
1 - Basically every day
2 - A few times a week
3 - A few times a month
4 - Once a month
5 - Less than once a month
6 - Not at all
Posting About Various Issues on Social Media
In the past 12 months, how often did you post your views
about political, societal, or local issues on the internet or social media?
1 - Basically every day
2 - A few times a week
3 - A few times a month
4 - Once a month
5 - Less than once a month
6 - Not at all
Reading, Watching, or Listening to News
In the past 12 months, how often did you read, watch or listen to news or information about political, societal, or local issues?
1 - Basically every day
2 - A few times a week
3 - A few times a month
4 - Once a month
5 - Less than once a month
6 - Not at all
Attending Public Meetings
In the past 12 months, did you attend a public meeting, such as a city council, school board, or zoning board meeting, to discuss a local issue?
Yes
No
Contacting a Public Official
In the past 12 months, did you contact or visit a public official – at any level of government – to express your opinion?
Yes
No
Choosing Services Based on Social or Political Values of Companies
In the past 12 months, did you buy or boycott products or services based on the political values or business practices of that company?
Yes
No
Voter Registration
States have different laws for how old you must be to register (or pre-register) to vote. When you become eligible, do you intend to register or pre-register to vote?
Yes, I'm already registered or pre-registered
Yes, I plan on registering or pre-registering when I become eligible
No
Does your participation in Youth and Government make you more likely to register to vote?
Please select...
Yes
No
Did your participation in Youth and Government encourage you to register to vote?
Please select...
Yes
No
Voting
Do you plan on voting in the next presidential election in 2024?
(You must be 18 years old on or before Tuesday, November 5th, 2024)
Yes, I plan on voting.
I will be old enough to vote, but do NOT plan on voting.
I will be old enough to vote, but I'm unsure if I will vote.
I won't be old enough to vote yet.
Does your participation in Youth and Government make you more likely to vote in the future?
Please select...
Yes
No
Belonging to Groups
In the past 12 months, did you belong to any groups, organizations, or associations in your school or community (clubs, teams, houses of worship, causes, etc.)?
Yes
No
Number of Groups
How many groups, organizations, or associations in your school or community would you say you have belonged to over the past 12 months?
Please select...
None
1
2
3
4
5 or more
Volunteering
In the past 12 months, did you spend any time volunteering for any organization or association?
Yes
No
How Often You Volunteer
How often did you volunteer?
1 - Basically every day
2 - A few times a week
3 - A few times a month
4 - Once a month
5 - Less than once a month
6 - Not at all
Volunteering Hours in a Year
In the past 12 months, approximately how many hours (total over the entire 12 months) did you volunteer?
Please select...
0-5 hours
5-10 hours
10-25 hours
25-50 hours
50-100 hours
100 or more hours
Addressing an Issue in Your School or Community
If you wanted to help address an issue or problem in your school or community, how prepared would you feel to:
A. Research and learn more about the issue
1 - Not Prepared
2 - Slightly Prepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Prepared
Does your participation in Youth and Government have any impact on how prepared you feel to
research and learn more about the issue?
Please select...
No Impact
Some Impact
Significant Impact
B. Come up with a plan to take action
1 - Not Prepared
2 - Slightly Prepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Prepared
Does your participation in Youth and Government have any impact on how prepared you feel to
come up with a plan to take action?
Please select...
No Impact
Some Impact
Significant Impact
C. Recruit others to join your efforts
1 - Not Prepared
2 - Slightly Prepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Prepared
Does your participation in Youth and Government have any impact on how prepared you feel to
recruit others to join your efforts?
Please select...
No Impact
Some Impact
Significant Impact
D. Connect with groups/organizations that care about the issue
1 - Not Prepared
2 - Slightly Prepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Prepared
Does your participation in Youth and Government have any impact on how prepared you feel to
connect with groups/organizations that care about the issue?
Please select...
No Impact
Some Impact
Significant Impact
E. Start a petition on the issue and gather signatures
1 - Not Prepared
2 - Slightly Prepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Prepared
Does your participation in Youth and Government have any impact on how prepared you feel to
start a petition on the issue and gather signatures?
Please select...
No Impact
Some Impact
Significant Impact
F. Schedule and host a meeting on the issue
1 - Not Prepared
2 - Slightly Prepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Prepared
Does your participation in Youth and Government have any impact on how prepared you feel to
schedule and host a meeting on the issue?
Please select...
No Impact
Some Impact
Significant Impact
G. Speak publicly on the issue in front of an audience
1 - Not Prepared
2 - Slightly Prepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Prepared
Does your participation in Youth and Government have any impact on how prepared you feel to
speak publicly on the issue in front of an audience?
Please select...
No Impact
Some Impact
Significant Impact
H. Convince someone who disagrees with your position on the issue to change their mind
1 - Not Prepared
2 - Slightly Prepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Prepared
Does your participation in Youth and Government have any impact on how prepared you feel to
convince someone who disagrees with your position on the issue to change their mind?
Please select...
No Impact
Some Impact
Significant Impact
I. Share your opinion with a local news/media outlet
1 - Not Prepared
2 - Slightly Prepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Prepared
Does your participation in Youth and Government have any impact on how prepared you feel to
share your opinion with a local news/media outlet?
Please select...
No Impact
Some Impact
Significant Impact
J. Contact a local official about the issue
1 - Not Prepared
2 - Slightly Prepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Prepared
Does your participation in Youth and Government have any impact on how prepared you feel to
contact a local official about the issue?
Please select...
No Impact
Some Impact
Significant Impact
K. Propose changes to rules, policies, or laws related to the issue
1 - Not Prepared
2 - Slightly Prepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Prepared
Does your participation in Youth and Government have any impact on how prepared you feel to
propose changes to rules, policies, or laws related to the issue?
Please select...
No Impact
Some Impact
Significant Impact
Additional Thoughts
Are there any additional thoughts you want to share about the civic health of your school or community?
Participant Feedback
As a participant in your state's YMCA Youth and Government program, please complete your survey by providing your feedback on the questions below:
Program Recommendation
As a program participant, on a scale of 0 (Not Likely) to 10 (Very Likely), how likely are you to recommend the Youth and Government program to a friend or peer?
0
1
2
3
4
5
6
7
8
9
10
Program Impact
On a scale of 0 (Least Impactful) to 10 (Most Impactful), how does your experience in the Youth and Government program compare to your other extracurricular experiences and commitments?
0
1
2
3
4
5
6
7
8
9
10
Personal Growth
Has your participation in the Youth and Government program helped you grow in any of the following areas?
Critical Thinking
Please select...
No Growth
Some Growth
Significant Growth
Research Skills
Please select...
No Growth
Some Growth
Significant Growth
Public Speaking
Please select...
No Growth
Some Growth
Significant Growth
Written Communication
Please select...
No Growth
Some Growth
Significant Growth
Relationship Building
Please select...
No Growth
Some Growth
Significant Growth
Collaborative Problem-Solving
Please select...
No Growth
Some Growth
Significant Growth
Time Management
Please select...
No Growth
Some Growth
Significant Growth
Emotional Management
Please select...
No Growth
Some Growth
Significant Growth
Future Plans
How has your participation in the Youth and Government program impacted your future plans?
College/Future Educational Plans
Please select...
No Impact
Some Impact
Significant Impact
Career Path & Professional Goals
Please select...
No Impact
Some Impact
Significant Impact
Remaining an Active Voter
Please select...
Less Likely
No Impact
More Likely
Running for Elected Office
Please select...
Less Likely
No Impact
More Likely
Most Important Program Experience
Finally, what would you consider to be the most important/impactful experience you've had while participating in the Youth and Government program?