* 1. I have children in the following age ranges (check all that apply):

* 2. When was the last time you talked with your child about attending parties where alcohol was available to teens?

* 3. How much of an issue do you think alcohol is in your community?

* 4. If your underage child was asked to attend an unchaperoned party where alcohol was available, how likely would you be to let your child go?

* 5. If your underage child was asked to attend a friend's chaperoned party where alcohol was available, how likely would you be to let your child go?

* 6. How upset would you be if your underage child was caught drinking?

* 7. I would allow my child and my underage child's friends to drink in my home as long as I took the keys and felt that "everyone was safe in my home".

* 8. I would like a local option to drug test my child at my request.

* 9. I am aware that there are free home drug-testing kits available at the local schools.

* 10. Substance abuse (marijuana, RX, etc.) is a serious issue among youth in my community.

* 11. I believe that underage drinking is a rite of passage.

* 12. Do you support marijuana being made legal for recreational use for those over the age of 18?

* 13. Do you support marijuana being made legal for medicinal use for a person with a qualifying medical condition?

* 14. How secure are prescription medications in your home?

* 15. Do you have unused or expired medicines in your home?

* 16. If you have expired meds, do you know that you can anonymously dispose of these at the local sheriff and police departments?

* 17. How safe is it to share prescription drugs?

* 18. How likely is it that prescription drug abuse leads to the use of heroin?

* 19. How much of an issue is heroin in Greensburg?

* 20. I would know where to turn for help if a family member was using substances.

* 21. During the past 12 months, I have heard or read about the Greensburg Prevention Group and its efforts to fight substance abuse.

* 22. I am aware that we have a local group, the Greensburg Prevention Group, addressing substance abuse issues in Greensburg.

* 23. Thank you for your time.  Please provide us with your contact information to be entered into a drawing for a gift card.

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