The Effects of Cell Phone Usage

Please complete the attached anonymous survey. Your responses will be strictly confidential and can never be linked to you. You may stop at any time. The data you provide will be part of an Intel National Science Talent Search entry. Please answer each question directly and honestly.
Your effort is greatly appreciated.
Thank You

1) Age: _______

2) Sex:

Male

Female

3) Grade: __________

4) Zip Code: _______

5) Ethnicity:

(1) White/Caucasian

(2) Black/African American

(3) Spanish/Hispanic/Latino

(4) East Asian/Southeast Asian [examples: Chinese, Korean, Vietnamese]

(5) South Asian [examples: Indian, Pakistani, Nepalese]

Other

8) Approximately, what is your unweighted GPA?

I would like to know what thoughts about life you've had during the past several weeks. Think about how you spend each day and night and then think about how your life has been during most of this time. Here are some questions that ask you to indicate your satisfaction with life. Circle the number (from 1 to 6) next to each statement that indicates the extent to which you agree or disagree with each statement. It is important to know what you REALLY think, so please answer the question the way you really feel, not how you think you should. This in NOT a test. There are NO right or wrong answers. Your answers will NOT affect your grades, and no one will be told your answers.

Circle 1 if you STRONGLY DISAGREE with the sentence
Circle 2 if you MODERATELY DISAGREE with the sentence
Circle 3 if you MILDLY DISAGREE with the sentence
Circle 4 if you MILDLY AGREE with the sentence
Circle 5 if you MODERATELY AGREE with the sentence
Circle 6 if you STRONGLY AGREE with the sentence

	1	2	3	4	5	6
My friends are nice to me

I am fun to be around

I feel bad at school

I have a bad time with my friends

There are lots of things I can do well

I learn a lot at school

I like spending time with my parents

My family is better than most

There are many things about school I don't like

I think I am good looking

	1	2	3	4	5	6
My friends are great

My friends will help me if I need it

I wish I didn't have to go to school

I like myself

There are lots of fun things to do where I live

My friends treat me well

Most people like me

I enjoy being at home with my family

My family gets along well together

I look forward to going to school

	1	2	3	4	5	6
My parents treat me fairly

I like being in school

My friends are mean to me

I wish I had different friends

School is interesting

I enjoy school activities

I wish I lived in a different house

Members of my family talk nicely to one another

I have a lot of fun with my friends

My parents and I do fun things together

	1	2	3	4	5	6
I like my neighborhood

I wish I lived somewhere else

I am a nice person

This town is filled with mean people

I like to try new things

My family's house is nice

I like my neighbors

I have enough friends

I wish there were different people in my neighborhood

I like where I live

Think about those things that have ACTUALLY caused you stress. Look at the categories below and circle the number that corresponds with the amount of stress that category has given you, on a scale from 1 (doesn’t cause me stress) to 9 (causes a great amount of stress for me). If something on this list has never caused you stress, circle/select 1.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday