We appreciate you taking the time to fill out this survey. This survey is completely confidential. Please answer as honestly as possible. This information will be used to improve the Monroe Clinic P.A.R.T.Y. program.

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* 1. Please select what school you attend

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* 2. What is your age?

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* 3. What is your gender?

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* 4. I wear a seat belt when I ride in a vehicle

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* 5. 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?

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* 6. During the past 30 days, how many times did you send text messages or read incoming text messages while driving or riding in a car with someone who was texting while driving? Please estimate the number of text messages sent or read.

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* 7. If I suspected that someone I was going to ride in a vehicle with was under the influence of alcohol and/or drugs, I would accept a ride from them

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* 8. The following behaviors may lead to risky decision making and/or injuries (check all that apply):

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* 9. During the past 30 days, how many times have you had alcohol, marijuana or other illegal drugs?

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* 10. I make safe choices

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* 11. Injuries can lead to: (Check all that apply)

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* 12. My choices can affect whether I get injured.

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* 13. Which part of the Monroe Clinic P.A.R.T.Y. Program did you find most powerful?

  5- Very powerful 4 3 - Neutral 2 1- Least powerful
Party/Car crash scene
EMS/Coroner's Scene
Guest Speaker - Dave (former MHS student, wheelchair-bound crash victim)
Emergency Room Scene
Morgue Scene
Guest Speaker - Jody (Coroner)
Guest Speaker - Darcey (crashed while under influence, motorcyclist fatality)
Courtroom Scene
Guest Speaker - Judge Tom Vale/Peter Kelly
Rehab/Home Scene with Family
Guest Speaker - Kaitlyn (crashed while texting and driving)
Contract for Life Scene

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* 14. I think that the Monroe Clinic P.A.R.T.Y. Program scenes are representative of real life.

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* 15. I think the experience of attending the Monroe Clinic P.A.R.T.Y. Program was beneficial for students my age.

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* 16. I think the experience of attending the Monroe Clinic P.A.R.T.Y. Program was beneficial for me personally.

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* 17. Did you sign Contract for Life with your parents, guardian, or other person?

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* 18. Did you share a KEY with someone?

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* 19. Please enter any thoughts, comments, suggestions you have about your experience of Monroe Clinic P.A.R.T.Y. Program.

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