TECH

General Information Survey

The following is a survey created by the TECH Crew for a study on teenage behaviors. The results of the survey will be displayed and compared in future months. Please answer all questions as honestly. Enjoy.

  1. What is your sex?
    Male Female

  2. What is your grade?


  3. What is your age?


  4. Where are you from?
    North East Mid-Atlantic South Great Lakes
    Central Pacific (includes Hawaii & Alaska)

  5. What is your financial status?
    Lower Class Middle Class Upper Class

  6. What is your ethnic background?
    African American Asian Caucasian Hispanic
    Middle Eastern Native AmericanOther

  7. With whom do you live?
    Two Natural Parents One Natural Parent
    A Natural Parent and a Stepparent Other Relative Guardian

  8. What is the highest level of education completed by your female guardian (mother, stepmother, etc.)?
    Middle School High School College Graduate School

  9. What is the highest level of education completed by your male guardian (father, stepfather, etc.)?
    Middle School High School College Graduate School

  10. How many friends do you have?
    None Few Average Many

  11. Is school important to you?
    Not Important Somewhat Important Important Very Important

  12. How much homework do you do per day?
    Less than 1 Hour 1 Hour 2 Hours 3 Hours More than 3 Hours

  13. When do you get the most work accomplished?
    Morning Afternoon Evening Late Night

  14. How do you work best?
    Alone One Other Person Small Group Large Group

  15. How much TV do you watch per day?
    Less than 1 Hour 1 Hour 2 Hours 3 Hours More than 3 Hours

  16. Do you get detentions and or suspensions?
    Never Not Usually Sometimes Frequently

  17. Are you involved in school sports?
    No Not Enough Time One Season
    More than One Season Every Season

  18. Are you involved in other sports or extra-curricular activities?
    No Not Enough Time Somewhat Involved
    Moderately Involved Very Involved

  19. Are you involved in hobbies or community activities?
    No Not Enough Time Somewhat Involved
    Moderately Involved Very Involved

  20. Do you work?
    No Not Enough Time One Day per Week
    A Few Days per Week All Week Long

  21. What do you do?


  22. Why do you work?


  23. What religious affiliation do you claim?
    Atheist Buddhist Catholic Protestant Hindu
    Jewish Mormon Muslim Eastern Orthodox Other

  24. Is religion important to you?
    Not Important Somewhat Important Important Very Important

  25. Are you influenced by your parents?
    Not at All Rarely Occasionally Usually Always

  26. If yes are you more greatly influenced by your mother or father?
    Mother Father

  27. Are you influenced by your siblings?
    Not at All Rarely Occasionally Usually Always

  28. If yes are you more greatly influenced by your brother or sister?
    Brother Sister

  29. Are you influenced by your friends?
    Not at All Rarely Occasionally Usually Always

  30. Are you influenced by your boyfriend/girlfriend?
    Not at All Rarely Occasionally Usually Always

  31. Are you influenced by your teachers?
    Not at All Rarely Occasionally Usually Always

  32. Are you influenced by newspaper or magazine advertising?
    Not at All Rarely Occasionally Usually Always

  33. Are you influenced by TV advertising?
    Not at All Rarely Occasionally Usually Always

  34. Do you smoke?
    No Tried It Less than One Pack a Day One Pack per Day
    Two Packs per Day More than Two Packs per Day

  35. Have you tried to quit smoking?
    Yes No

  36. Do your parents smoke?
    No Mother FatherBoth

  37. Do your parents allow you to smoke?
    Yes No

  38. Do your friends smoke?
    Yes No

  39. Do you drink alcohol?
    Not at All Rarely Occasionally Usually Always

  40. Do your parents consume alcohol?
    No Mother FatherBoth

  41. If so how often?
    Do Not Drink Rarely Occasionally Usually Always

  42. Do your parents allow you to drink alcohol?
    Yes No

  43. Do you use other drugs?
    Yes No

  44. Do your parents use any other drugs?
    Do Not Use Drugs Rarely Occasionally Usually Always

  45. Are you sexually active?
    Yes No

  46. Do you have a license?
    Yes No

  47. Do you wear a seat belt?
    Yes No

  48. Do you believe the warning labels on cigarette packs and advertising?
    Yes No

  49. Do you believe cigarette companies are honest?
    Yes No

  50. If for any of the questions above you selected not enough time please delete the words "Enough Time" and very briefly tell us why?

Thank You

Thank you for taking the time to answer the questions in our survey.

The information collected through this survey serve two purposes. First, the information gives us a better understanding of how to better improve our site to fit your needs. Second, a tally of the results of our survey will be displayed for you to see how the majority responded to the survey. We recommend you check your responses before you submit your survey otherwise send it in and if there are any questions that you think should not have been included in this survey or if there is a question you would like to see in future surveys let us know in the feed back page which will follow the submission of this form.

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Copyright © 1996 Julianne , Anthony , and Brandon . All rights reserved.
Revised: August 16, 1996.