ID # _________________

Your Opinions Count

THANK YOU for taking part in this survey. The purpose of this survey is to find out about the experiences and opinions of students your age in cities like Atlanta, Georgia, San Antonio, Texas, Miami, Florida, and Portland, Oregon. Hundreds of students from across the country will be filling out copies of this survey.

Your survey is confidential and your name will not appear on it. Some of the questions are about serious topics like drugs and alcohol. Please answer the questions truthfully. This is not a test. There are no right or wrong answers.

Please answer all of the questions. If you need help understanding a question, ask one of the adults who gave you the survey. They are there to help you.

PRACTICE QUESTIONS

Filling out the survey is easy. Just fill in the circle below the answer you choose.

How often do you do each of the following things in your free time?

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

Pretty Often

Not Very Often

Never

A	Watch television

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B.	Read a book

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C.	Listen to music

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D.	Play a sport

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Other questions ask how strongly you agree or disagree with a statement.

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

Agree a Lot

Agree a Little

Don’t Agree

E.	I like reading books better than listening to music.

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F.	I would rather listen to music than watch television.

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G.	I like reading books.

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H.	I don’t like playing sports.

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1.	Please write the month, day, and year that you were born:	____________	_____	_____

For example, January 1 1981	Month	Day	Year

How often are the following statements true about you?

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

Always

True

Sometimes

True

Never

True

2.	I have a lot in my life to look forward to.

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3.	I don’t think I will be a very successful person.

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4.	Nothing ever goes right for me.

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5.	I feel good about the future.

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How often are the following statements true about you?

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

Always

True

Sometimes

True

Never

True

6.	I think it is important to work hard in school.

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7.	The things I learn in school are interesting.

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8.	I like to learn new things in school.

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9.	It is important to me to be a good student.

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Do you think it is okay for students your age to do the following things?

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

Always Okay

Sometimes Okay

Never Okay

10.	Drink alcohol

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11.	Smoke cigarettes/Dip snuff

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12.	Smoke marijuana

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13.	Sell drugs

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14.	Abuse prescription drugs/pills

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15.	Use inhalants (sniff glue)

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Are the following statements true or false about the friends you hang out with?

(CHOOSE EITHER TRUE OR FALSE FOR EACH STATEMENT)

True

False

16.	My closest friends do not drink alcohol.

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17.	My closest friends use drugs (marijuana, pills, inhalants, etc.)

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18.	My closest friends attend school regularly (do not skip school).

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19.	My closest friends get into trouble at school.

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20.	My closest friends belong to gangs.

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How often do you do each of the following?

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

Pretty Often

Sometimes

Not Very Often

Never

21.	I do things that I know are wrong just to be more popular with my friends.

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22.	I let my friends talk me into doing things I really don’t want to do.

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23.	I worry about letting my friends down.

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24.	I try to do things that will impress my friends.

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25.	I “go along with the crowd” even if it might get me into trouble.

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In the past three months, how often have you done the following things?

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

Pretty Often

Sometimes

Not Very Often

Never

26.	Carried a weapon (knife or gun)

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27.	Got in a fight where I hit or was hit by someone

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28.	Smoked cigarettes or chewed tobacco

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29.	Drank alcohol

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30.	Used drugs (marijuana, pills, inhalants, etc.)

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31.	Decided not to cheat on a school test or assignment when I could have

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32.	Damaged someone else’s property or belongings

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33.	Skipped a day of school

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34.	Worked towards doing good things on your own

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35.	Threw dangerous objects at cars or people

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36.	Brought alcohol or drugs to school

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37.	Used force to get money or things from someone

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38.	Broke into, or tried to break into, a car or building

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39.	Disobeyed your parent/guardian (Did something they told you not to do)

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40.	Told the truth to your parent/guardian about something you did wrong

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41.	Participate in a gang

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42.	Stole or tried to steal something

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43.	Tried to do better in school

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The following statements are about adults who are not your parents (for example, teachers and coaches).

How strongly do you agree or disagree with the following things?

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

Agree A Lot

Agree A Little

Don’t Agree

44.	The adults I know, who are not my parents, let me decide things for myself.

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45.	The adults I know, who are not my parents, give me enough responsibility.

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46.	The adults I know, who are not my parents, are interested in what I have to say.

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47.	I have a lot of respect for the adults I know, who are not my parents.

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48.	I can talk with the adults I know, who are not my parents, when I have a problem.

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How strongly do you agree or disagree with the following statements?

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

Agree A Lot

Agree A Little

Don’t Agree

49.	The kids I know are not very friendly to me.

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50.	I feel that I am very close to my family.

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51.	I often feel left out of things that others are doing.

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52.	Most people accept me when I am just being myself.

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53.	I have friends I can turn to when I have a problem.

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How strongly do you agree or disagree with the following statements?

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

Agree A Lot

Agree A Little

Don’t Agree

54.	I am able to do things as well as most people.

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55.	I feel I do not have a lot to be proud of.

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56.	I feel that the longer people know me, the more they like about me.

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57.	I am satisfied with myself.

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58.	I often feel that I am a failure.

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How easily could you do each of the following things?

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

I could do it by myself

I could do it only with help

I could not do it

59.	Could you read a story in a magazine or book?

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60.	Could you write a letter to a friend?

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61.	Could you draw a picture of something in your neighborhood?

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62.	Could you play on a sports team?

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63.	Could you write a report about the kind of work you have been doing?

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64.	Could you build something?

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65.	Could you act out a scene in a play?

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How interested are you in doing the following things?

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

Very interested

A little interested

Not at all interested

66.	Visiting an art museum

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67.	Writing for fun (story, poem, journal, diary)

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68.	Going to a dance performance

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How many hours each week would you be willing to do the following for your community?

(CHOOSE ONE ANSWER FOR EACH STATEMENT)

5 or more hours

3-4 hours

1-2 hours

None

69.	Help other kids with their homework

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70.	Clean up the neighborhood by picking up trash along the streets

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71.	Help improve the look of the neighborhood by planting flowers or painting a mural

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72.	Recycle aluminum cans, newspapers, etc.

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When you are finished with this survey, please close the booklet and stay in your seat until the adult who gave you the survey comes by to collect it.

THANK YOU FOR COMPLETING THIS SURVEY

6

ID # _________________

rebecca schaffer

1998-09-10

Technology Coordinator

Dell Computer Corporation