Porter County Fair Youth Questionnaire Survey

Question Title

* 1. What is your gender?

Male

Female

Transgender (either male or female)

Gender Fluid

Prefer not to answer

Question Title

* 2. How old are you?

10 Years or younger

11 Years Old

12 Years Old

13 Years Old

14 Years Old

15 Years Old

16 Years Old

17 Years Old

18 Years old

19 Years old or older

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* 3. What race/ethnicity best describes you?

American Indian or Alaskan Native

Asian/Pacific Islander

Black or African American

Hispanic/Latino

White/Caucasian

Multiple ethnicity/Other (please specify)

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* 4. Which of the following best describes your current living situation?

Living at home with both parents.

Living at home with mom.

Living at home with dad.

Living at home with grandparent.

Living with a family member other than my parents.

Living with a friend and not with my parents.

Other (please specify)

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* 5. What school will you be attending in the fall?

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* 6. What grade level will you be in the fall?

5th Grade or below

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

Recent High School Graduate (Class of 2017)

Not currently enrolled in school

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* 7. How would you describe your performance in school?

Mostly A's

Mostly B's

Mostly C's

Mostly D's

Mostly F's

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* 8. On a scale of 1 to 10 where 1 is extremely uncomfortable and 10 is extremely comfortable how comfortable do you feel at your school?

1 (extremely uncomfortable)

10 (extremely comfortable)

1 (extremely uncomfortable)

10 (extremely comfortable)

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* 9. On a scale of 1 to 10 where 1 is very unstressed and 10 is extremely stressed how stressed out do you feel at your school?

1 (very unstressed)

10 (extremely stressed)

1 (very unstressed)

10 (extremely stressed)

Question Title

* 10. Which of the following statements best describes your school attendance?

I have never missed a day of school.

I only miss school when it is absolutely necessary.

I rarely skip school. (once or twice a year)

I skip school occasionally. (once or twice a month)

I skip school regularly. (once or twice a week)

Question Title

* 11. Which of the following statements best describes you?

I participate in a few sports and/or clubs. (at least one but no more than three)

I participate in several sports and/or clubs. (more than three)

I have never participated in any sport or club but I would like to.

I have never participated in any sport or club and do not want to.

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* 12. Which of the following sports have you participated in? (check all that apply)

Basketball

Baseball/Softball

Football

Wrestling

Gymnastics

Track & Field

Cheerleading/Rally Squad

Swimming/Diving

I have never participated in a sport.

Other (please specify)

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* 13. Have you ever had an athletic injury?

Yes

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* 14. If yes, has anyone other than a doctor treated you for the injury with prescription drugs that you did not receive from a pharmacy?

Yes

Don't Know

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* 15. Which of the following activities do you participate in?

Drama/Theatre

Student Leadership/ASB

Music/Band

GLBTQ

Other (please specify)

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* 16. Which of the following best describes your plans after high school?

I have no plan yet.

Go to a college, university or trade school.

Join the military.

Get a full-time job.

Other (please specify)