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• Your child lived with someone who had a problem with drinking or using drugs. • Your child often felt unsupported, unloved, or unprotected.
2) Of the following statements in Section 2, HOW MANY apply to your child?
Write the number in the box
Section 2: At any point since your child was born:
Your child was in foster care.
•
• Your child experienced harassment or bullying at school. • Your child lived with a parent or guardian who died. • Your child was separated from her or his primary caregiver through deportation or immigration. • Your child had a serious medical procedure or life-threatening illness. • Your child often saw or heard violence in the neighborhood or in her or his school neighborhood. • Your child was often treated badly because of race, sexual orientation, place of birth, disability, or religion.
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