# PBC SURVEY PART 2Exit this survey

1. Do you turn your cell phone off at night?
 Do you turn your cell phone off at night?   a. Yesb. No
2. Do you share a bedroom with others?
 Do you share a bedroom with others?   a. Yes, with one other personb. Yes, with more than one other personc. No, I have my own roomd. I don’t sleep in a bedroom
3. What time do you go to bed? Between:
 What time do you go to bed? Between:   a. 9:00 – 10:00 pmb. 10:00 – 11:00 pmc. 11:00 – 12:00 amd. 12:00 – 1:00 ame. 1:00 – 2:00 amf. Other_________
4. Do you drink coffee, tea, or other caffeinated beverages (i.e. Coke, Pepsi, energy drinks) after 3:00pm?
 Do you drink coffee, tea, or other caffeinated beverages (i.e. Coke, Pepsi, energy drinks) after 3:00pm?   a. Yesb. Noc. Sometimes
5. How many hours of sleep do you get on an average school night?
 How many hours of sleep do you get on an average school night?   a. 10 hrs.b. 9 hrs.c. 8 hrs.d. 7 hrs.e. 6 hrs.f. 5 hrs.g. Less than 5 hrs.h. More than 10 hrs.
6. What is your wake-up time? Between:
 What is your wake-up time? Between:   a. 5:00 – 6:00 amb. 6:00 – 7:00 amc. 7:00 – 8:00 amd. Other __________
7. About what time do you usually arrive at school?
 About what time do you usually arrive at school?   a. 7:15 amb. 7:20 amc. 7:25 amd. 7:30 ame. 7:35amf. 7:40 amg. 7:45 amh. 7:50 ami. 8:00 amj. After 8:00 amk. Other ___________
8. Do you eat breakfast?
 Do you eat breakfast?   a. Yes, I eat breakfast at homeb. Yes, I eat breakfast at schoolc. Yes, I stop and pick something up on the wayd. No, I don’t like to eat breakfaste. No, I don’t have time to eat breakfast
9. Do you use your school planner?
 Do you use your school planner?   a. Yesb. No
10. Do you make a “to do” list every day?
 Do you make a “to do” list every day?   a. Yesb. Noc. Sometimes