Survey Questions
Section 1: Community-Related Belonging Questions (#1-5)
| CATEGORY | Question | Response Scale |
| COMMUNITY BELONGING | How would you describe your sense of belonging to the community? Would you say it is:
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-Response Scale:
-Very weak -Somewhat weak -Somewhat strong -Very strong
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| COMMUNITY BELONGING (Preferred) | This question asks how much you feel you belong.
Choose the picture that shows how close you feel to each group.
a. Your local neighbourhood b. Your city (Kitchener, Waterloo, Cambridge or the specific township) c. [The program] *d. Your faith-based group *E. Your cultural group(s) *e. School (e.g., classes, amongst classmates, with teachers) *f. School extracurriculars (e.g., afterschool sports or clubs) *g. Community programs (e.g., youth groups, recreational programs or drop-in centres) *h. Place of volunteering *i. Online groups (e.g., social media groups) j. Family k. Friends
*Indicates optional or “non-core” questions
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Does not apply/not sure |
| Related to the “ATTACHMENT” and “VALUED, HEARD AND INCLUDED” Pillars | 4. Thinking about your day-to-day interactions with those around you, please indicate your agreement with the following statements:
a. I feel a strong emotional bond with at least one other person. b. I have relationships where my competence and skill are recognized. c. I feel part of a group of people who share my attitudes and beliefs. d. I have people I can depend on to help me when I really need it. e. When I speak, I feel like someone in my life listens.
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4 point scale: Strongly Agree, Agree, Disagree, to Strongly Disagree |
| Related to the EQUITY pillar | In the past year, have you experienced discrimination or been treated unfairly by others in your community because of who you are?
(For example, because of your gender, culture, race, appearance, faith, sexual orientation, age, first language, a chronic illness or disability, your living situation, or another reason.) |
4 point scale: Strongly Agree, Agree, Disagree, to Strongly Disagree |
Section 2: Program-Related Belonging Questions (#6-10)
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| CATEGORY | Old Version | Updated Version (for 7-13 year olds)
Note: If we are keeping this section, we should define “a short/long time” or be more specific to ensure all children have the same measurement of time in mind. |
| INFORMATION ABOUT PARTICIPATION IN PROGRAM
(provides context to other belonging questions and allows for comparison of virtual and in-person programming) |
6a. How long have you been involved with [program]?
OR
6a. How long did you(/have you) live(d) at [program]?
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-I just started
-A short time -A long time
0-3 months 3-6 months More than 6 months
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| 6b. How often do you attend [program] or similar programs with this organization?
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-First Time
-Rarely -Sometimes -Regularly |
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| 6c. How do you participate in [program] or similar programs with this organization?
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-Online only
-Mostly online but sometimes in person -Mostly in person but sometimes online -In person only |
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| 6d. What is your preferred format for programs like this with [program]?
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-Online only
-Mostly online but sometimes in person -Mostly in person but sometimes online -In person only |
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| 6e. How did you find out about [program]?
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Open answer | |
| 6f. How has participating in [program] changed things for you?
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Open answer | |
| 6g. How can we improve [program] to better serve you?
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Open answer | |
| CORE BELONGING QUESTIONS | 7. Please indicate your agreement with the following statements:
As part of the [program] …
a. I feel I can share my ideas while participating b. I feel I am being treated fairly c. I have friends and/or valuable connections
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4 point scale: Strongly Agree, Agree, Disagree, to Strongly Disagree |
| Related to the “ATTACHMENT” and “VALUED, HEARD AND INCLUDED” Pillars | 8. Thinking about the [program], please indicate your agreement with the following statements:
a. I can depend on my program facilitators to help me when I really need it b. Other people in the [program] share my attitudes and beliefs c. When I speak, I feel like my fellow participants listen to me. d. When I speak, I feel like the facilitators listen to me. e. In the [program], my competence and skill are recognized. f. I would feel comfortable if other participants reached out to me in the future. g. Even after a bad day at [program], I still feel I belong in the [program]. h. I have close relationships with other people in the [program].
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4 point scale: Strongly Agree, Agree, Disagree, to Strongly Disagree |
| Related to the EQUITY Pillars | 9. We want to understand what it’s like being part of the [program]. Indicate your agreement with the following statements:
In the [program]…
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4 point scale: Strongly Agree, Agree, Disagree, to Strongly Disagree |
Section 3: Demographic Questions (5 questions) |
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| DIMENSION | Old Version
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Updated Version (for 7-13 year olds)
Note: Can keep the old version. |
| AGE | How old are you? I am _ years old
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Numerical |
| GEOGRAPHY | Where do you live most of the time?
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-Cambridge
-Kitchener -Waterloo -North Dumfries Township -Wellesley Township -Wilmot Township -Woolwich Township -I don’t know -I prefer not to answer |
| GENDER IDENTITY | Which gender do you identify with most?
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-Woman or girl
-Man or boy -Non-binary, gender-variant, and/or Two Spirit -Unsure -Prefer not to say -Another gender (please describe) |
| TRANSGENDER | Do you identify as transgender?
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-Yes
-No -Unsure -Prefer not to answer |
| IDENTITY | Do you identify as any of the following? (Please select all that apply.)
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-Person of Colour
-First Nations, Métis, or Inuit (Inuk) -Sexual orientation minority (e.g., queer, asexual, pansexual, Two-Spirit, lesbian, gay) -Person with a disability -Born outside Canada -English is not a first language -Low income -None of the above -Prefer not to say |