MVA 'YOU Hold the Keys' Survey

1. Default Section

1. What is your zip code?

What is your zip code?

2. Do you practice any of the following with your teen driver?

	Always	Often	Sometimes	Rarely	Never
Require seat belt use?	*Do you practice any of the following with your teen driver? Require seat belt use? Always	Require seat belt use? Often	Require seat belt use? Sometimes	Require seat belt use? Rarely	Require seat belt use? Never
Restrict the number of passengers?	Restrict the number of passengers? Always	Restrict the number of passengers? Often	Restrict the number of passengers? Sometimes	Restrict the number of passengers? Rarely	Restrict the number of passengers? Never
Warn about speeding?	Warn about speeding? Always	Warn about speeding? Often	Warn about speeding? Sometimes	Warn about speeding? Rarely	Warn about speeding? Never
Prohibit the use of cell phones while driving?	Prohibit the use of cell phones while driving? Always	Prohibit the use of cell phones while driving? Often	Prohibit the use of cell phones while driving? Sometimes	Prohibit the use of cell phones while driving? Rarely	Prohibit the use of cell phones while driving? Never
Limit nighttime driving?	Limit nighttime driving? Always	Limit nighttime driving? Often	Limit nighttime driving? Sometimes	Limit nighttime driving? Rarely	Limit nighttime driving? Never
Warn about drinking and driving?	Warn about drinking and driving? Always	Warn about drinking and driving? Often	Warn about drinking and driving? Sometimes	Warn about drinking and driving? Rarely	Warn about drinking and driving? Never
Set your own rules over and above what is required by law?	Set your own rules over and above what is required by law? Always	Set your own rules over and above what is required by law? Often	Set your own rules over and above what is required by law? Sometimes	Set your own rules over and above what is required by law? Rarely	Set your own rules over and above what is required by law? Never
Exhibit model behavior when your teen is the passenger in your vehicle?	Exhibit model behavior when your teen is the passenger in your vehicle? Always	Exhibit model behavior when your teen is the passenger in your vehicle? Often	Exhibit model behavior when your teen is the passenger in your vehicle? Sometimes	Exhibit model behavior when your teen is the passenger in your vehicle? Rarely	Exhibit model behavior when your teen is the passenger in your vehicle? Never

3. I believe that the information in the "YOU Hold the Keys" brochure will influence me to become more involved with my teen driver during the:

	Strongly Agree	Agree	Neither	Disagree	Strongly Disagree
Learner’s Permit Stage	*I believe that the information in the "YOU Hold the Keys" brochure will influence me to become more involved with my teen driver during the: Learner’s Permit Stage Strongly Agree	Learner’s Permit Stage Agree	Learner’s Permit Stage Neither	Learner’s Permit Stage Disagree	Learner’s Permit Stage Strongly Disagree
Provisional License Stage	Provisional License Stage Strongly Agree	Provisional License Stage Agree	Provisional License Stage Neither	Provisional License Stage Disagree	Provisional License Stage Strongly Disagree

4. Did you attend a parent orientation program at your teen’s driver education school?

Did you attend a parent orientation program at your teen’s driver education school? Yes

No, it was not offered at my teen’s school

No, it was offered at my teen’s school, but I did not attend

No, it was not offered at my teen’s school, but I would have attended

5. How often does your teen drive?

How often does your teen drive? 1-2 times per week

3-4 times per week

5-6 times per week

Daily

Occasionally

6. Does your teen…

Does your teen… Use his/her own vehicle

Use the family vehicle

Has no access to a vehicle

7. Does your teen…

Does your teen… Drive whenever he/she wants

Need permission before driving

Has no access to a vehicle

8. What is your teen’s current phase of licensure?

What is your teen’s current phase of licensure? Learner’s Permit

Provisional License (first 18 months of licensure)

Full License (18 or more months of licensure)

None

9. What is your relationship to the teen driver in your household?

What is your relationship to the teen driver in your household? Mother

Father

Stepmother

Stepfather

Grandmother

Grandfather

Other

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