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:

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: