Chester County Government Forms

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Youth Post-Placement Survey

  1. Placement Evaluation for Youth
  2. Surveys are only reviewed by Chester County Juvenile Probation Department and will NOT be shared directly with the placement provider
  3. 1. The program was as explained to me.
  4. Check one*
  5. 2. The placement staff listened to what I had to say.
  6. Check one*
  7. 3. I had input into my treatment plan.
  8. Check one*
  9. 4. The placement staff followed the treatment plan.
  10. Check one*
  11. 5. My education needs were met.
  12. Check one*
  13. 6. The placement staff were committed to my best interest and safety.
  14. Check one*
  15. 7. I felt safe in placement with staff and peers.
  16. Check one*
  17. 8. My probation officer or someone from Juvenile Probation visited me each month.
  18. Check one*
  19. 9. I was able to reach my probation officer without difficulty.
  20. Check one*
  21. 10. I was able to reach my family without difficulty.
  22. Check one*
  23. 11. Residents could get illegal drugs or alcohol while in the program.
  24. Check one*
  25. 12. My medical and dental needs were met.
  26. Check one*
  27. 13. I had input into my discharge plan.
  28. Check one*
  29. 14. I received job skills and life skills training.
  30. Check one*
  31. 15. Overall, I was pleased with the placement's service.
  32. Check one*
  33. PLEASE NOTE- The Chester County Juvenile Probation Department is legally mandated to report all abuse allegations, so you will be contacted directly if you note any concerns of that nature.
  34. Leave This Blank:

  35. This field is not part of the form submission.