1. Did a parent or other adult in the household often or very often... swear at you, insult you, put you down, or humiliate you OR act in a way that made you afraid that you might be physically hurt? * No Yes Unsure/Skip
2. Did a parent or other adult in the household often or very often push, grab, slap, or throw something at you? OR ever hit you so hard that you had marks or were injured? * No Yes Unsure/Skip
3. Did an adult or person at least 5 years older than you ever... touch or fondle you in a sexual way or have you touch their body in a sexual way OR attempt or actually have oral, anal, or vaginal intercourse with you? * No Yes Unsure/Skip
4. Did you often or very often feel that... no one in your family loved you or thought you were important or special OR that your family didn’t look out for, feel close to, or support each other? * No Yes Unsure/Skip
5. Did you often or very often feel that... you didn’t have enough to eat, had to wear dirty clothes, or had no one to protect you OR that your parents were too drunk or high to take care of you or take you to the doctor if you needed it? * No Yes Unsure/Skip
6. Were your parents ever separated or divorced or was a parent ever lost to you through abandonment? * No Yes Unsure/Skip
7. Was a parent or other adult in your household... often or very often pushed, grabbed, slapped, or had something thrown at them? OR sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? OR ever repeatedly hit over at least a few minutes or threatened with a gun or knife? * No Yes Unsure/Skip
8. Did you live with anyone who was a problem drinker, alcoholic, used illegal drugs or abused prescription medications? * No Yes Unsure/Skip
9. Did you ever live with anyone who was depressed, mentally ill, or suicidal or did a household member attempt suicide? * No Yes Unsure/Skip
10. Did you live with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility? * No Yes Unsure/Skip
Now add up your “Yes” answers. This is your ACE Score:
Did you often or very often feel unsafe in your neighborhood? * No Yes Unsure/Skip
Did you often or very often feel that you were treated badly or unfairly because of your race, sexual orientation, place of birth, disability or religion? * No Yes Unsure/Skip
Did you ever see or hear someone being beaten, shot, or stabbed in real life? * No Yes Unsure/Skip
Did your family often or very often have to cut the size of meals or skip meals because there was not enough money in the budget for food? * No Yes Unsure/Skip
Were you ever in foster care? * No Yes Unsure/Skip
Did you ever experience frequent or severe harassment or bullying by a peer or classmate? * No Yes Unsure/Skip
Did you live with a parent or guardian who died? * No Yes Unsure/Skip
Were you separated from your primary caregiver through deportation or immigration? * No Yes Unsure/Skip
Did you experience a serious medical procedure or life threatening illness? * No Yes Unsure/Skip
...feel able to talk to your family about feelings?
...feel your family stood by you during difficult times?
...enjoy participating in community traditions?
...feel a sense of belonging in high school?
...feel supported by friends?
...have at least two non-parent adults who took genuine interest in you?
...feel safe and protected by an adult in your home?
...feel people in your neighborhood looked out for each other, stood up for each other, and could be trusted?
