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* 1. Age

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* 2. Grade you just completed (2020-2021 school year).

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* 3. Gender

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* 4. Race/Ethnicity

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* 5. During COVID (between spring of 2020 to present), I have felt: CHOOSE ALL THAT APPLY

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* 6. During COVID-19 (between spring of 2020 to present), I have found ways to cope (or deal with the situation) which have helped me during COVID-19.

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* 7. During COVID-19 (between spring 2020 to present) I have (choose all that apply)

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* 8. I have a good support system that helped me during COVID-19 (between spring 2020-present).

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* 9. My use of vapes/tobacco has ______ as a result of COVID-19 (between spring 2020-present)

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* 10. My use of marijuana has ______ as a result of COVID-19 (between spring 2020-present).

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* 11. My use of alcohol has ______ as a result of COVID-19 (between spring 2020-present).

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* 12. My use of prescription drugs NOT PRESCRIBED TO ME has ____ as a result of COVID-19 (between spring 2020-present).

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* 13. COVID-19 has negatively impacted my mental health. (I.e., felt anxious, depressed, isolated, sad, not able to feel joy in things I used to)

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* 14. My relationship with my parents (or legal guardians, if different than your biological parents) has _______ as a result of COVID-19 (between spring 2020-present).

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* 15. My relationship with my siblings has _______ as a result of COVID-19 (between spring 2020-present).

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* 16. My relationship with friends has _______ as a result of COVID-19 (between spring 2020-present).

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* 17. What feelings do you have about the 2021-2022 school year?

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* 18. Given a choice, what would you like the 2021-2022 school year to look like?

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* 19. What things are you worried about related to life and school after COVID-19?

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* 20. What would help you most at this time?

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