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2013
February
F
FNL Research Suvery Pre
FNL Research Suvery Pre
Substance Use Survey
0%
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Hello:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.
Thank you very much for your time and support. Please start with the survey now by clicking on the
Continue
button below.
How old are you?
-- Select --
12
13
14
15
16
17
18
19
Please choose your grade level.
Freshman
Sophomore
Junior
Senior
Please choose your gender.
Male
Female
In the
last month
have you:
Drank any alcohol
Bringe(consuming four or more drinks in 2 hours or less)
Driven under the influence of alcohol
Ridden with a driver who was under the influence of alcohol
Have your
ever
:
Drank any alcohol
Bringe(consuming four or more drinks in 2 hours or less)
Driven under the influence of alcohol
Ridden with a driver who was under the influence of alcohol
In the
last month
have you used:
Marijuana
Cocaine
Heroin
Prescription drugs that were not yours
None
Other
Have you
ever
used:
Marijuana
Cocaine
Heroin
Prescription drugs that were not yours
None
Other
Have you ever been offered?
Alcohol
Drugs
Tobacco
Thank your for partcipation.
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