2. Ohio Youth Assessment System Disposition Tool Self-Report Questionnaire
4. Please fill this out to the best of your ability. Your responses will be used to help make the best decisions regarding your situation.
6. Name:*
7. Date:*
   Date:
9. 1. How old were you when you first got in trouble with the law?*
11. a. What did you do to get in trouble?*
13. 2. My family is important to me.*

    1. Strongly agree
    2. Agree
    3. Disagree
    4. Strongly disagree
15. 3. How likely are you to follow your parents' rules?*

    1. No contact
    2. Not at all
    3. Some
    4. A lot
    5. Always
17. 4. How often do you get into arguments with adults?*

    1. Not at all
    2. Some
    3. A lot
    4. Always
19. 5. My family wants me to stop getting in trouble.*

    1. Strongly agree
    2. Agree
    3. Disagree
    4. Strongly disagree
21. 6. My friends get into physical fights.*

    1. A lot
    2. Sometimes
    3. Never
23. 7. Have you ever been arrested with any of your friends?*

    1. No
    2. Yes
25. 8. My friends/family are part of a gang.*

    1. No
    2. Yes
27. 9. My friends are important to me.*

    1. Strongly agree
    2. Agree
    3. Disagree
    4. Strongly disagree
29. 10. How many times have you been suspended from school?*

    1. 0
    2. 1
    3. 2
    4. 3+
31. 11. When was the last time you were suspended?
33. 12. How many times have you been expelled from school?*

    1. 0
    2. 1
    3. 2
    4. 3+
35. 13. How many of your teachers or other school staff do you have a positive relationship with?*
37. 14. Have you ever been employed?*

    1. No
    2. Yes
39. 15. If yes, how do you get along with your boss?

    1. Not at all
    2. Somewhat
    3. OK
    4. Good
    5. Very good
41. 16. How old were you the first time you used drugs?*
43. 17. When was the last time you used drugs?*
45. 18. When was the last time you used alcohol?*
47. 19. How likely are you to quit using drugs?*

    1. Never used
    2. Highly unlikely
    3. Unlikely
    4. Likely
    5. Highly likely
49. 20. On a scale of 1 to 10 rate yourself on how cool you are? (10 is the most cool)*
51. 21. On a scale of 1 to 10 how cool would your friends rate you? (10 is the most cool)*
53. 22. I can stop breaking the law.*

    1. Strongly agree
    2. Agree
    3. Disagree
    4. Strongly disagree
55. 23. There are some good things about gangs.*

    1. Strongly agree
    2. Agree
    3. Disagree
    4. Strongly disagree
57. 24. I am friends with people in a gang.*

    1. No
    2. Yes
59. 25. Have you ever experienced any of the following?
61. a. Neglect:*

    1. No
    2. Yes
63. b. Sexual Abuse:*

    1. No
    2. Yes
65. c. Physical Abuse:*

    1. No
    2. Yes
67. Probation Officer

    1. Ashley Cornish
    2. Bethany Smith
    3. Briana Mruk
    4. Cassie Noramczyk
    5. Dan Whalen
    6. David Flores
    7. Erika Cornejo
    8. Kevin Kennedy
    9. Mark Bronke
    10. Sharon Kramer
    11. Tesha Robertson
Leave This Blank:


69. Submit Submit and Print

* indicates a required field