Survey Page6

Home Survey Page6

[Page1]
[Page2]
[Page3]
[Page4]
[Page5]
[Page6]
[Page7]
  1. SINCE SCHOOL BEGAN IN THE FALL, on how many DAYS have you… (DARKEN ONE BUBBLE FOR EACH LINE: a-e.)

    None 1-3 day 4-9 days 10+ days
    a. missed a whole day of school because you "skipped" or "cut"?
    b. missed a whole day of school because you were ill?
    c. missed a whole day of school for some other reason?
    d. been sent by a teacher to someone like the Principal, Dean, or Guidance Counselor because of your conduct or attitude?
    e. had someone from your home be called to school because of your conduct or attitude?


  2. DURING THE PAST 12 MONTHS, how many times (if any) have you… (DARKEN ONE BUBBLE FOR EACH LINE: a-d.)

    None 1-3 day 4-9 days 10+ days
    a. gotten into difficulties of any kind with your friends because of your drinking?
    b. driven a car when you've had a good bit to drink?
    c. gotten into difficulties of any kind with your friends because of your drug use?
    d. driven a car when you've felt high from drugs?


  3. SINCE SCHOOL BEGAN IN THE FALL, on how many DAYS (if any) have you attended at least one class while “high,” “drunk,” or “stoned” on… (DARKEN ONE BUBBLE FOR EACH LINE: a-d.)

    None 1-3 day 4-9 days 10+ days
    a. beer, wine coolers (hard lemonade, hard sodas, hard cider), wine, or hard liquor?
    b. marijuana?
    c. inhalants?
    d. some other drug(s)?


  4. Alcohol or other drugs are sometimes used at teenage parties. Thinking of parties you attended this school year… (DARKEN ONE BUBBLE FOR EACH LINE: a-b.)

    Never Seldom Half the time Most of the time Always Don't Know Didn't attend any parties
    a. how often was alcohol used?
    b. how often were marijuana and/or other drugs used?


  5. SINCE SCHOOL BEGAN IN THE FALL, have you sought help, other than from family or friends, for problems in any way connected with your use (if any) of alcohol, marijuana, or other drugs?
    1. Yes
    2. No
  6. If you had a drug or alcohol problem and needed help, who would you go to? (DARKEN ONE BUBBLE FOR EACH LINE: a-i.)

    Yes No
    a. A counselor or program in school?
    b. A school nurse?
    c. Another adult in school (such as a teacher or coach)?
    d. Your parents?
    e. A medical doctor?
    f. Your friends?
    g. Another adult (such as a relative, clergyman, or other family friend)?
    h. A counselor or program outside of school?
    i. I wouldn't go to anyone.


  7. SINCE SCHOOL BEGAN IN THE FALL, have you gotten any information on drugs or alcohol from the following SCHOOL sources? (DARKEN ONE BUBBLE FOR EACH LINE: a-h.)

    Yes No
    a. A school health class?
    b. An assembly program at school?
    c. A school guidance counselor?
    d. A school nurse?
    e. A science or social study class?
    f. A student group or club meeting at school?
    g. An invited school guest?
    h. Another source at school?