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THIS IS AN ANONOMOUS SURVEY – DO NOT PROVIDE YOUR NAME Gender (circle one) Male Female Grade (circle one) 9 10 11 12 Overall GPA (circle one) 0-1.5 1.5-2.5 2.5-3.5 3.5-4 >4 Have you ever drunk alcohol recreationally? (circle one) Yes No If yes, when did you first drink recreationally? (circle one) Before grade 7 (please specify ________) Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 If yes, how often, on average, do you drink recreationally? (circle one) Never Less than once a month Once a month Once a month to less than once a week Once a week More than once a week Have you ever tried marijuana? (circle one) Yes No If yes, when did you first try marijuana? (circle one) Before grade 7 (please specify ________) Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 If yes, how often, on average, do you use it? (circle one) Never Less than once a month Once a month Once a month to less than once a week Once a week More than once a week OVER Have you ever tried any other drugs illegally? (circle one) Yes No If yes, please name the drug(s), time of first use, and frequency of use according to the choices given in previous questions: | Name of drug | Time of first use | Frequency of use | |
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| On a scale of 1-10, how big of a problem do you think drug/alcohol use is at SHS? (circle one) Biggest problem 10 9 8 7 6 5 4 3 2 1 Not a problem If you answered yes to any of the above questions: Why do you choose to use drugs/alcohol recreationally? Why did you originally choose to use drugs/alcohol recreationally? Do you think your drug/alcohol use will affect your health later in life? (circle one) Yes No Please explain: FOLD YOUR SURVEY BEFORE TURNING IT IN TO THE ENVELOPE PROVIDED TO YOUR HOMEROOM ADVISOR
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