| 
                
                
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            | 
                
                
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            | 
                
                
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            | 
                
                
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            | 
                
                
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            | 
                
                
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            | 
                
                
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            | 
                
                
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| In the last two weeks, how many times have you had five or more drinks? (a drink is considered a bottle of beer, glass of wine, shot of liquor) |  
  |   |  
 |  
  |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| Average number of drinks you consume a week: |  
  |   |  
 |  
  |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
11. At what age did you first use... 
 |  
  |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
| 12. Within the last year about how often have you used...
 |  
  |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
13. How often do you think the average student on camups uses... 
 |  
  |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
14. During the past 30 days on how many days did you have: 
 |  
  |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
| 15. How often have you experienced the following due to your drinking and/or drug use during the last year...
 |  
  |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
16. Within the last year what was your involvement inthe following activities? 
 |  
  |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
17. Do you think alcohol has the following effects? 
 |  
  |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
18. On campus, do you believe drinking is central to the following social groups? 
 |  
  |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| What is your grade point average? |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
20. When you are at the following places, how many drinks do you typcially have? 
 |  
  |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| Compared to other campuses in which you are familar, your campus' use of alcohol is... |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
|   |  
 |  Do you have any suggestions about how your school can help students become more aware of the dangers of drugs? Any policies you feel should be inacted?  |   |   |  
  |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 |