Question Title * 1. Which site do you attend? East Austin College Prep Academy (Charter School) East Austin Community Development Center (Centro de Familia) Boys and Girls Clubs of Central Texas (On-Site) Question Title * 2. Are you: Male Female Question Title * 3. Which grade are you in? 6th 7th 8th 9th 10th 11th 12th Other (please specify) Question Title * 4. How old are you? 11 12 13 14 15 Other (please specify) Question Title * 5. During the past 12 months, how many times have you been in a physical fight on school property? 0 times 1 time 2-3 times 4-5 times 6 or more times Question Title * 6. During the past 12 months, have you been a member of a gang? Yes No Question Title * 7. During the past 12 months, on how many days did you drink a glass, can or bottle of alcohol (beer,wine,wine cooler, hard liquor)? None 1-2 days 3-5 days 6-9 days 10 or more days Question Title * 8. During the past 12 months, on how many days did you smoke marijuana? None 1-2 days 3-5 days 6-9 days 10 or more days Question Title * 9. During the past 12 months, on how many days did you smoke cigarettes? None 1-2 days 3-5 days 6-9 days 10 or more days Question Title * 10. During the past 12 months, on how many days did you use other drugs? None 1-2 days 3-5 days 6-9 days 10 or more days Question Title * 11. During the past 12 months, have you felt depressed, sad or hopeless for two consecutive weeks? Yes No Question Title * 12. During the past 12 months, have you participated in any mental health programs? Yes No Question Title * 13. During the past 12 months, have you participated in any group counseling sessions related to drug and gang prevention? Yes No Question Title * 14. During the past 12 months, have you participated in any local community service projects? Yes No Question Title * 15. During the past 12 months, have you participated in any in-school or after-school enrichment activities? (leadership development, tutoring, mentoring, college preparation, career readiness, field trips, and competitions) Yes No Question Title * 16. Do you plan on graduating from high school? Yes No Question Title * 17. Do you plan on going to college? Yes No Question Title * 18. Do your parents encourage you to do well in school? Yes No Question Title * 19. Do your parents encourage you to go to college after you graduate from high school? Yes No Question Title * 20. Have you participated in the East Austin Children's Promise program? Yes No Question Title * 21. Has communication with your parents increased because of the East Austin Children's Promise program and services? Yes No Question Title * 22. Overall, how would you rate East Austin Children's Promise programs and services? Excellent Above Average Average Poor Very Poor In this school year, did you..... Question Title * 23. Participate in clubs, organizations or activities at school? Yes No Question Title * 24. Think it's okay to cheat at school? Yes No Question Title * 25. Try to do well in school? Yes No Next
