| # | Question |
|
1
|
Have you been arrested in the last 3 months?
|
|
Yes
No
|
|
2
|
How much harm do you think people risk (physically or in other ways) if they use tobacco, alcohol, or other drugs?
|
|
1
2
3
4
5
6
7
8
9
10
|
|
No Risk Slight risk Some risk
High risk Great risk
|
|
3
|
Do you think it is wrong for someone your age to get into a physical fight with someone?
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Not
at all
Slightly wrong Wrong
Pretty wrong Very wrong
|
|
4
|
Overall, how do you feel like you get along with others?
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Not
at all
A little
Average
Well Very well
|
|
5
|
How often have you done what feels good no matter the consequences?
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Never
Seldom Occasionally
Often All the time
|
|
6
|
Putting them all together, what are your grades like now?
|
|
Mostly A's
Mostly B's
Mostly C's
Mostly D's
Mostly F's
|
|
7
|
How important do you think the things you are learning in school are going to be for your later life?
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Not at all
Slightly important Somewhat important
Important Very important
|
|
8
|
Have you been suspended/expelled during the last three months of school attendance?
|
|
Yes
No
|
|
9
|
Is there conflict/violence in your family and/or neighborhood?
|
|
1
2
3
4
5
6
7
8
9
10
|
|
None
Seldom Occasionally Often Every day
occurrence
|
|
10
|
Think of your four best friends (the friends you feel closest to). In the past three months, have your best friends been arrested or been suspended/expelled?
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Never Seldom Occasionally Often
Multiple times
|
|
11
|
On how many occasions the last 90 days, if any, have you smoked cigarettes (including e-cigarettes), used alcohol, illegal drugs, or misused prescription drugs?
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Never Seldom Occasionally Often
Every day
|
|
12
|
How easy would it be for you to get alcohol, marijuana or other drugs?
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Impossible Very hard
Hard
Easy Very easy
|
|
13
|
Are you involved in activities (such as sports teams, scouting, boys and girls clubs, academic clubs, 4-H, leadership clubs) in my school/community?
|
|
Yes
No
|
|
14
|
When you are not at home, one of your parents/guardians knows where you are and who is with you?
|
|
Yes
No
|
|
15
|
There are adults in your life you could talk to about something important.
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Strongly disagree Disagree
Neutral Agree
Strongly agree
|
|
16
|
There are opportunities for students in your school to talk with a teacher one-on-one.
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Strongly disagree Disagree
Neutral Agree
Strongly agree
|
|
17
|
If you had a personal problem, you could ask your parents/guardian or other adult for help.
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Strongly disagree Disagree
Neutral Agree
Strongly agree
|
|
18
|
Overall, you believe that your life has meaning/purpose.
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Strongly disagree Disagree
Neutral Agree
Strongly agree
|
|
19
|
All in all, you believe you can accomplish things in life.
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Strongly disagree Disagree
Neutral Agree
Strongly agree
|
|
20
|
Overall, how do you get along with your family?
|
|
1
2
3
4
5
6
7
8
9
10
|
|
Not
at all
A little
Somewhat
Well Very well
|
