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Exit Survey
 
 
How old are you?
 
14 or under
 
15
 
16
 
17
 
18 or older
 
 
 
Male or Female
 
Male
 
Female
 
I have no gender
 
I am both genders
 
 
 
What grade are you in?
 
9th
 
10th
 
11th
 
12th
 
 
 
How many hours of sleep do you get a night?
 
5 or less
 
6
 
7
 
8
 
9 or more
 
 
 
What time do you go to bed?
 
8 pm or earlier
 
9 pm
 
10 pm
 
11 pm
 
12 pm or later
 
 
 
What time do you fall asleep?
 
5 minutes or less
 
10 to 30 minutes after you go to bed
 
30 to 60 minutes after you go to bed
 
more than 60 minutes after you go to bed
 
 
 
What time do you normally wake up?
 
6 am or earlier
 
7 am
 
8 am
 
9 am
 
10 am or later
 
 
 
What do you usually eat before bed (Select all that apply)?
 
Cereal
 
Junk food (chocolate,chips,cakes,etc.)
 
soft drinks/tea
 
energy drinks
 
milk
 
water
 
fruits and/or vegetables
 
leftovers
 
sandwiches

 
 
 
List all the things you do on a nightly basis (Select all that apply)?
 
Texting
 
Social Media
 
Tv/movies
 
Music
 
Homework
 
Reading
 
Thinking/thought/daydreaming
 
other

 
 
 
Are you physically active after school?
 
No
 
Occasionally
 
Everyday