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1. What School does your child attend? If you have students in middle and high school, please answer for one age group at a time.

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2. Which grade is your teen in school?

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3. What ethnicity do you identify with? Check all that apply. (Required due to receipt of grant funding)

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4. When was the last time you talked to your teen about not using alcohol?

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5. Do you have clear rules against:

  Yes No
Alcohol Use
Marijuana Use
Nicotine/Vaping

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6. Where do YOU as a parent/guardian get your information regarding alcohol, marijuana or vaping? (check all that apply)

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7. In our community, teenage use of the following substance is a problem...

  Strongly Agree Agree Disagree Strongly Disagree
Alcohol
Marijuana
Nicotine/Vaping

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8. Do you know parents/guardians/adults who host parties where the following substances are available or served to teenagers?

  Alcohol Marijuana Nicotine/Vaping
Yes
No

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9. Are you familiar with your local Social Host Ordinance and the liability if teens use substances on your property, even if you are not present?

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10. Has your teen been to a friend's house or party where alcohol and/or other substances were available or served to them?

  Alcohol Marijuana Nicotine/Vaping
Yes
No
I don't know

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11. If you knew your teenager was going to a party where alcohol and/or other substances might be available or served, would you be to let them go?

  Alcohol Marijuana Nicotine/Vaping
Yes
No
I don't know

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12. Which statement below best represents your attitude about teen use of the following substances?

  Alcohol Marijuana Nicotine/Vaping
Never a good thing for anyone at any age
In moderation is alright for adults, but never for people under 21
Occasional use is OK if it doesn't interfere with schoolwork or other responsibilities

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13. Would you know if your child had been....

  Yes No I don't know
Drinking Alcohol
Using Marijuana
Using Nicotine/Vaping

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14. During the past year, do you remember seeing or hearing any of the following substance use prevention initiatives? Select all that apply.

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15. Has your child talked to you about any of the following substance use prevention initiatives at their school? Select all that apply.

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16. Have you safely disposed of over the counter or prescription medications? Select all that apply.

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17. How would you like to receive teen drug and alcohol prevention education? Select all that apply.

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18. If you would like to receive information from Link Together Coalition, please add your email address below. 

Always Moving Forward, we all play a part in keeping our youth safe, healthy and substance-free!

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