Child and Youth Questionnaire

A questionnaire designed to let children and teens describe, in their own words, their interests, school life, and everyday preferences.

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Name (optional)

First Name

Last Name

Age

Gender

Male Female

What grade are you in?

What is your favorite subject in school? Why?

Do you participate in any extracurricular activities or sports?

Yes No

If yes, please tell us about them.

What are your favorite hobbies or things to do in your free time?

If you could learn something new, what would it be?

How much time do you spend on electronic devices each day?

Less than 1 hour 1-3 hours 3-5 hours More than 5 hours

What is your favorite TV show, movie, or video game? Why do you like it?

Who is your favorite family member, and why?

Do you have any siblings?

Yes No

If yes, tell us about them.

How do you feel about school?

What makes you happy, sad, or excited?

Is there anything else you would like to share with us?

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