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Select Gender
 
Male
 
Female
 
 
 
What Grade are you currently in?
 
9
 
10
 
11
 
12
 
12+
 
 
 
If answered yest to question three, which of these drug(s) have you done? (Select all that apply)?
 
Alcohol
 
Marijuana
 
Cocaine
 
MDMA
 
Other
 

 
 
What range would your grade avarage fall into?(check which apply)
0-50% 51-60% 61-70% 71-80% 81-90% 91-100%
Math
English
Science
Total Grade Average
 
 
 
How often do you use illegal substances?
 
Rarely
 
Occasionally
 
Often
 
Daily
 
Never
 
 
Rate the availablility of the following illegal substances (1-Most accessible,10-least)
1 2 3 4 5 6 7 8 9 10
Alcohol
Marijuana
Cocaine
MDMA
 
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