The following is a list of questions in DYB pertaining to student level information. It is organized by page in DYB.
Student Profile
Name: __________________________________________
What is the student’s sex?
Female
Male
Other/Intersex
Birth Date: _______________________
With what race and/or origin does the student identify?
White
Enter origin such as German, Irish, Lebanese, etc. _______________________________
Black or African American
Enter origin such as African American, Haitian, Nigerian, etc. __________________________________
Hispanic, Latino, or Spanish Origin
Enter origin such as Mexican, Mexican American, Puerto Rican, Cuban, Columbian, etc. ___________________________________
American Indian or Native Alaskan
Enter origin such as Navajo, Mayan, Tingit, etc. _________________________________
Asian or South Asian
Enter origin such as Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Hmong Laotian, Thai, Pakistani, etc. __________________________________________
Native Hawaiian or other Pacific Islander
Enter origin such as Native Hawaiian, Guamanian or Chamorro, Samoan, Fijian, etc.________________________________
Other race or origin
Enter other race or origin ___________________________________________________
What is the student’s marital status?
Married
Single
Widowed
Divorced
Civil Union
Partner/Cohabitating
Unknown
Was this student a parent or primary caregiver at entry to YouthBuild?
Parent
Primary Caregiver
Both parent and primary caregiver
Neither
Is this student currently homeless or have they been homeless in the last year?
Currently homeless
Homeless in past year
Neither
Unknown
Has the student ever been in foster care?
Currently in foster care
Aged out of or no longer in foster care
Never in foster care
Unknown
Is this student economically disadvantaged?
Yes
No
Is the student an English language learner?
Yes
No
Does the student identify as LGBTQ?
Yes
No
Unknown
Was the student employed for any part of the 6 months before entry into YouthBuild?
Yes
No
Unknown
If this student enrolls in postsecondary education will they be a first generation enrollee?
Yes
No
Unknown
Does this student identify as having a disability?
Yes
No
Unknown
Is this student registered to vote? (asked if over 18 years old)
Yes
No
Not Eligible to Vote
Unknown
Criminal Justice
Was this student a youth or adult offender before entry into YouthBuild?
Youth Offender
Adult Offender
Both Youth and Adult Offender
Neither
Unknown
What was the student’s most recent release date (if known)? __________________
What was the student’s court involvement at entry into YouthBuild (if involved at entry)?
On parole/probation
In detention/incarcerated
Case pending
None
What was the level of the most serious offense (if involved at entry)?
Felony
Misdemeanor
Non-Criminal Offense
Unknown
Did this student become court involved after entering YouthBuild? (question asked at exit)
Convicted of a new crime
Parole / Probation Revoked
No involvement
Unknown
If selected Convicted of new crime or Parole / Probation revoked: What was the date of the student’s court involvement incident? ____________
Enrollment
Enrollment Date: ___________________________
Exit Reason:
Successful Exit
Left program to return to high school
Chose to leave before meeting requirements for completion
Was asked to leave for disciplinary reasons
Moved from target area of program
Left for medical reasons
Incarcerated
Left to care for an ill or disabled family member
Active reservist called to military duty
Deceased
Left for other reasons
Exit Date: _________________________
Exit Additional Details: ______________________________________________________________________
Return Date (if applicable): ___________________________
Student’s Email Address: (asked at exit) _________________________________
What was the student’s attendance percentage during the program? (asked at exit) ______
How many hours of community service did the student participate in during YouthBuild? (asked at exit) ____________________
Contact Information
Student’s Email Address: __________________________________________________
Phone Number: _________________________________
Street Address: _______________________________________________________________________
City: ______________________________________
State: ___________
Twitter: __________________________________________________
Facebook: ________________________________________________
Education Profile
How many years was the student out of school before enrolling in YouthBuild? __________________________
Reading Grade Level
Grade Level: ________________________ Test Date: __________________ (Pre-test)
Grade Level: ________________________ Test Date: __________________ (Post-test)
Math Grade Level
Grade Level: ________________________ Test Date: __________________ (Pre-test)
Grade Level: ________________________ Test Date: __________________ (Post-test)
Diploma and High School Equivalency
Educational Credential at Entry:
High School Diploma
High School Equivalency
No Credential
Educational Credential Earned After Entry
High School Diploma
GED
HISET
TASC
Other Equivalency
None
Educational Credential date (if awarded after entry): ________________________________
Post Secondary Goals
Initial Desired PSE Credential
Associates Degree
Bachelor’s Degree
Graduate/Professional Degree
Certificate
Apprenticeship Placement
Employment only
Post Secondary Prep Achievements (questions asked at exit)
Did this student earn post secondary credits at your program?
Yes
How many post secondary credits did this student earn?
No
Unknown
Did this student complete a FAFSA while at your program?
Yes
No
Unknown
Did this student take a college placement test?
Yes
No
Unknown
Did the student complete any post secondary applications?
Yes
No
Unknown
Certificates
Certificate Name:
NCCER
MCCC
BPI
HBI PACT
CNA
PCA
HHA
Customer Service Excellence
CPR/First Aid
OSHA 10
OSHA 30
Driver’s License
CDL
HAZMAT
Other
Date Received: ________________________________
If Other:
Certificate Name: _______________________________________
Type:
Construction
Customer Service
Healthcare
Hospitality
Foundational
Other
Industry Recognized:
Yes
No
If NCCER: Please choose any/all NCCER curricula completed:
Core Curriculum
Weatherization Level 1
Weatherization Level 2
Your Role in the Green Environment
If BPI: Please choose any/all BPI curricula completed:
RBE-WH-ALCI
Building Analyst
RBE-AA-ALCI
Activities
Activity Type:
Barista Training
College Bridge Program
Internship
Mental Toughness 2 (MT2)
Mentoring
Policy Committee Member
Activity Start Date: _______________________
If Mentoring:
What kind of mentoring did the student receive?
Group
Individual
Both
Was the mentor a Youth Opportunity AmeriCorps Mentor?
Yes
No
If Internship:
Internship Name: ___________________________________________________
Placements
Job Placement
Employer Name: _____________________________________________________________
Start Date: ____________________________________________________________________
End Date (only if job placement has ended): _______________________________________
Type of Job:
Architecture, and engineering
Arts, design, entertainment, sports, and media
Building and grounds cleaning, and maintenance
Business and financial operations
Community and social services
Computers, Information Technology, Math
Construction and extraction
Education, training, and library
Farming, fishing, and forestry
Food preparation and serving related
Healthcare support, practitioners, and technical
Installation, Maintenance, and repair
Legal
Life, physical, and social science
Management
Military specific
Office and administrative support
Personal care and service
Production
Protective service
Sales and related
Transportation and material moving
Unknown job type
Hours:
Full Time Employment
Part Time Employment
Unknown
Is this placement a green job?
Yes
No
Unknown
What is the starting wage for this student’s placement? ______________________________
Education Placement
What is the name of this Post Secondary Institution or apprenticeship? ____________________________________________
Enrollment Date: ____________________________________
Where is this student getting their continuing education?
College or University
Community College
Trade School/Non-College Training Program
Registered Apprenticeship Training
Is this placement full time or part time?
Full Time
Part Time
Unknown
If selected College or University:
Is the college or university a public or private school?
Public
Private
Unknown
Details (If selected College or University, Community College or Trade School / Non-College Training Program):
How many credits has the student earned at this placement? (Asked at exit only of PSE Initiative Programs) ___________________
What credential is the student working towards at this placement?
Bachelors Degree
Associates Degree
Technical Credential
Graduate/Professional Degree
Apprenticeship Credential
Other
Unknown
If selected Registered Apprenticeship Training:
Apprenticeship Details:
What is the training wage for this apprenticeship? ___________________________
In what sector is this apprenticeship?
Construction
Healthcare
Retail
Other
What kind of organization sponsors this apprenticeship?
Employers / Industry
Trade Associations
Unions
Followup
Education Placement:
Verify
Unable to Verify
End Placement
If Verify: When did you follow up with the student? _____________
If Unable to Verify: When did you attempt to contact the student? _______________
If End Placement: Date: _____________
What was the result of this educational placement?
Graduated / Completed Successfully
Family Care
Pursuing Employment
Transferred to another institution
Criminal Justice Involvement
Financial Difficulties
Other
If Graduated/Completed Successfully:
What type of degree or credential was earned at this placement?
Bachelors Degree
Associates Degree
Technical Certification
Graduate / Professional Degree
Apprenticeship Credential
Other
If Bachelors Degree, Associates Degree, Graduate / Professional Degree:
What was the field of study or major for the degree received?
STEM
Non-STEM
Academic
Healthcare
Business
Manufacturing
Other
If Technical Certification, Apprenticeship Credential, or Other:
What is the name of the credential earned? _________________________
Article Keywords / Topics: Data Points, List of Questions