Introduction and Demographics

This survey is about things that can impact your physical and mental health.  It has been developed so you can tell us the things that may be impacting you.  The information you give will be used to develop better health education and services for young people like yourself. 
Your name is not collected and is not part of this survey.  The answers you give will be kept private.  No one will know how you respond.  Please answer the questions based on your experiences. 

Completing the survey is voluntary.  Whether or not you answer the questions will not affect your grade(s) in any way.  If you are not comfortable answering a question, just leave it blank.

The questions that ask about your background will be used only to describe the types of students completing this survey in general.  Once again, no names will ever be reported.

Make sure to read every question.  While taking this survey or after completing this survey, if you are bothered by any of the content please talk to a guidance counselor, teacher or other trusted adult.  When you are finished, follow the instructions of the person giving you the survey.   

Thank you very much for your help.

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* 1. How old are you?

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* 2. What is your gender?

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* 3. In what grade are you?

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* 4. How do you describe yourself?

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* 5. Are you Hispanic, Latino or Spanish origin?