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  5. Sleep Habits Survey
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Hello:
You are invited to participate in my Sleep Habits survey. In this survey, approximately 30 people will be asked to complete a survey that asks questions about their sleep habits. It will take approximately 10 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. If you feel uncomfortable answering any questions, you can withdraw from the survey at any point.

Please remember, there are no right or wrong answers. I just ask of you to answers these survey questions truthfully.

Thank you very much for your time and support.
 
 
 
What is your gender?
 
Male
 
Female
 
 
 
How old are you?
 
12
 
13
 
14
 
15
 
16
 
17
 
18
 
19
 
 
 
What grade are you in?
 
9
 
10
 
11
 
12
 
 
 
In the last two weeks, have you slept in the same bed?
 
Every night
 
Almost every night
 
A few nights
 
Not at all
 
 
Who lives in your house other than you?
Yes No
Mother
Father
Older brother(s)/sister(s)
Younger brother(s)/sisters(s)
Other
 
 
 
Are your grades in school mostly:
 
A's
 
A's and B's
 
B's
 
B's and C's
 
C's
 
C's and D's
 
D's
 
D's and F's
 
 
 
What is the highest grade in school to expect to complete?
 
May not finish high school
 
Will finish high school
 
Will go to college
 
May not go to college
 
Will finish college
 
 
 
Compared to other people your age, would you say that your health is:
 
Very poor
 
Poor
 
Fair
 
Good
 
Excellent
 
 
 
Do you have any disabilities or chronic illnesses?
 
Yes
 
No