2025-26 YOUTH Choice Pass Survey

Please complete this short survey and answer all questions honestly.  Your responses will remain anonymous.
Note to parents: In order to obtain honest responses, it is critical that you student complete this survey on their own.

Once the survey is complete click DONE on the last page to finish registering for Choice Pass.
1.Which school do you currently attend?(Required.)
2.What is your gender?(Required.)
3.What grade are you in?(Required.)
4.Which race/ethnicity best describes you? (Please choose only one.)(Required.)
5.What languages do you speak at home? (check all that apply)(Required.)
6.Rank each option for why you choose to be in Choice Pass.(Required.)
Importance rating
To motivate me to make healthy choices
To hang out with friends
For a discounted ski pass
For other discounts
Because my friends are in Choice Pass
Because my community celebrates my healthy choices
Because my parents want me to be in Choice Pass
7.Do you participate in any extracurricular activities at school such as sports, band, drama, clubs, or student government?(Required.)
8.Read each of the following statements and indicate your level of agreement based on how you describe yourself at this time.(Required.)
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
I understand my strengths.
I feel confident with myself.
I have a parent or guardian I can go to for help with a personal problem.
It is easy for me to talk with my parents or guardians about alcohol and drugs.
There are opportunities for students at my school to attend alcohol/drug free events outside of class.
I know who to go for help with a personal problem in school.
I know who to go for help with a personal problem outside of school.
I have an adult that is not a parent or guardian I can go to for help with a personal problem.
9.In the past 30 days have you (check all that apply):(Required.)
10.During the past 30 days, on how many days do you think a typical student at your school:(Required.)
Mark one
smoked cigarettes?
drank alcohol?
had 5 or more drinks of alcohol in a row, that is, within a couple of hours?
used marijuana?
taken a prescription drug (such as
OxyContin, Percocet, Vicodin, codeine,
Adderall, Ritalin, or Xanax) without a doctor's prescription?
vaped?
zyned?
Used drugs or alcohol?
11.How much do you think people risk harming themselves (physically or in other ways) if they:(Required.)
Mark one
smoke one or more packs of cigarettes per day?
have one or two drinks of alcohol nearly every day?
use marijuana regularly?
vape regularly?
use drugs or alcohol regularly?
zyn regularly?
12.During the past 12 months, have you talked with at least one of your parents/guardians about the dangers of tobacco, alcohol, or drug use?(Required.)
13.During the past 12 months, have you talked with at least one of your parents/guardians about healthy relationships and sex/consent?(Required.)
14.During the past 12 months, have you talked with at least one of your parents/guardians about anxiety, stress, and/or mental health?
15.During the past 12 months, have you talked with at least one of you your parents/caregivers about social media and/or gaming?
16.During the past 30 days, how many times did you ride
in a car or other vehicle driven by someone who had
been drinking alcohol?(Required.)
17.Do your parents/guardians create a safe and drug/alcohol free place at home to hang out with your friends?(Required.)
18.My parents/guardians allow me to (select all that apply):(Required.)
19.I have felt so sad or hopeless almost every day for two weeks or more in a row during the past 12 months that I have stopped doing some usual activities
20.What issues are your friends currently dealing with?(select all that apply)(Required.)
21.What types of events would you like to go to? (check all that you are interested in)(Required.)
Thank you for completing the Choice Pass Program Survey!

Get your mom or dad and click ONLINE REGISTRATION!