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How old are you?
 
12
 
13
 
14
 
15
 
 
 
Are you a male or female?
 
male
 
female
 
 
 
Are you eligible for or do you:
 
received a free lunch
 
reduced lunch
 
neither
 
 
 
Who works in your family (choose all that apply)?
 
mom
 
dad
 
guardian
 
 
 
How often do you attend a religious service?
 
Weekly
 
Monthly
 
Occasionally
 
Very Seldom
 
Never
 
 
 
Are you actively involved in activites at school?
 
Always
 
Most of the time
 
Occasionally
 
Seldom
 
Never
 
 
 
Have you ever had any form of physical contact with the opposite gender?
 
yes
 
no
 
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