District (please check one)






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Are you male or female?


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What do you want to be when you grow up?

During the past year, how many times have you moved (changed where you live)?


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Please check one answer about how you feel about each of the following statements.

I have goals and plans for the future.





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I plan to graduate from high school.
true




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I plan to go to college or some other school after high school.





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I know where to go for help with a problem.





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I try to work out problems by talking or writing about them.





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I can work out my problems.





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I can do most things if I try.





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I can work with someone who has different opinions than mine.





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There are many things that I do well.





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I feel bad when someone gets their feelings hurt.






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I try to understand what other people go through.





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When I need help, I find someone to talk with.





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I have a friend about my own age...

who really cares about me.





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who talks with me about my problems.





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who teases me too much.





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who helps me when I'm having a hard time.





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My friends...

get into a lot of trouble.





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try to do what is right.





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Do well in school




How true are these statements about your HOME or the ADULTS WITH WHOM YOU LIVE?


In my home, there is a parent or some other adult...


who expects me to follow the rules.





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who is interested in my school work.





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who believes that I will be a success.





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who is too busy to pay much attention to me.





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who talks with me about my problems.





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who always wants me to do my best.





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who listens to me when I have something to say.




At home...

I do fun things or go fun places with my parents or other adults.





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I do things that make a difference.





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I help make decisions with my family.




How true are these statements about school?


School is a waste of time





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I do interesting activities at school.





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I try to do well at school





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If I study hard, I will get better grades.





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I would like to quit school as soon as I can.




At school, I help decide things like class activities or rules.




I do things at my school that make a difference.




At my school, there is a teacher or some other adult...

Who really cares about me.




Who tells me when I do a good job.




Who notices when I'm not there.




Who is mean to me.




Who always wants me to do my best.




Who listens to me when I have something to say.




Who believes that I will be a success.




Outside of my home and school, there is an adult...

Who really cares about me.




Who tells me when I do a good job.




Who notices when I'm upset about something.




Who believes I will be a success.




Who always wants me to do my best.




Whom I trust.




Please check one answer about how true you feel each of the following statements are for you.

I enjoy working together with other students my age.





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I stand up for myself without putting others down.





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I try to understand how other people feel and think.





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There is a purpose to my life.





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I understand my moods and feelings.





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I understand why I do what I do.




I feel like I am all alone in the world.




I am part of clubs, sports teams, church/temple or other group activites away from school.




Outside of my home and school, I participate in music, arts, sports, or a hobby.




Outside of my home, I help other people.




I am confused about what I want out of life.




How true are these statements about you?

When I am mad, I yell at people




Sometimes I break things on purpose.





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If I feel like it, I hit people





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How often do you talk with your parents or other adults in your home about...

your plans for the future?




problems with your friends?





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how well you get along with your teachers?





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Have you ever smoked a cigarette?



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Have you ever chewed tobacco or snuff (dip)?

Have you ever drunk beer, wine, or other alcohol?



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Have you ever sniffed something through your nose to get "high"?


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Have you ever smoked any marijuana (pot, grass, weed)?



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Have you ever used alcohol or an illegal drug like marijuana before school or at school?


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Do you think smoking cigarettes is bad for a person's health?



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Do you think drinking alcohol (beer, wine, liquor) is bad for a person's health?



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Do you think using marijuana (pot, grass, weed) is bad for a person's health?




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In the past month (30 days), did you drink any beer, wine, or alcohol?



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If yes, how many days in the past month (30 days) did you drink beer, wine, or other alcohol?







In the past month (30 days), did you smoke a cigarette?

If yes, how many days in the past month (30 days) did you smoke cigarettes?







In the past month (30 days), did you use smokeless (chewing) tobacco?


If yes, how many days in the past month (30 days) did you use
smokeless tobacco?









In the past month, did you smoke marijuana?



If yes, on how many occasions during the last 30 days have you used
marijuana (grass, pot) or hashish (hash, hash oil)?






 

How wrong do you think it is for someone your age to drink beer, wine, or hard liquor (for example, vodka, whiskey or gin) regularly?




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How wrong do you think it is for someone your age to smoke cigarettes?




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How wrong do you think it is for someone your age to smoke marijuana?





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How wrong do your parents feel it would be for you to...


drink beer, wine, or hard liquor (for example, vodka, whiskey or gin)?




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drink beer, wine, or hard liquor (for example, vodka, whiskey or gin) regularly?




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smoke cigarettes?




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smoke marijuana?




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How would your parents or other adults in your family feel if you attended a party where alcoholic beverages were available?





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Did you understand the questions on this survey?



Some of them


Did you answer the questions on this survey honestly and truthfully?


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What language do you usually speak at home?


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