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* 1. What is the date today?

Date

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* 2. Which of the below programs were you involved in?

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* 3. How long were you involved in the programs? (Please write number of semesters)

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* 4. What year did you graduate?

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* 5. What are you currently doing?

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* 6. Please rate how much you agree with the below statements regarding the impacts that Journey had on your ability to:

  Strongly Agree Agree Disagree Strongly disagree
Recognize and manage my emotions
Set and achieve positive goals
Demonstrate caring and concern for others
Establish and maintain positive relationships
Make responsible decisions
Handle interpersonal situations effectively
Defined purpose in life
Understand that I am unconditionally loved
Reflect on and think about my faith and/or spirituality
Express my feelings and emotions in an appropriate way

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* 9. Please tell us how Journey influenced your thinking and behavior about substance use (drug and/or alcohol) while you were were in high school.

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* 10. How did the Journey experience influence your present day thinking and behaviors regarding substance use?

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* 11. On average, how many hours a day do you spend on:

  never less than one hour about 1-2 hours about 2-3 hours about 3-4 hours more than 4 hours
Watching video content (TV, YouTube, movies, etc.)
Listening to music
Doing your homework
Emailing, or posting messages on Facebook (NOT including Facebook chat)
Texting or instant messaging (including Facebook chat)
Talking on the phone or video chatting
Participating in face-to-face conversations

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* 12. If you answered yes to any of the above questions involving media and technology use, how often are you using more than one type of media at the same time?

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* 13. How has your participation in Journey impacted the way you use technology?

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* 15. Please answer the below questions as truthfully as possible

  None of the time A little of the time Some of the time A lot of the time Most of the time All of the time
I think I am doing pretty well
I can think of many ways to get things in life that are most important to me
I am doing just as well as other people my age
When I have a problem I can come up with lots of ways to solve it
I think the things I have done in the past will help me in the future
Even when others want to quit, I know that I can find ways to solve the problem
Have trust in myself and others
Believe in my ability to accomplish what I set out to do

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* 16. Would you recommend Journey to a student currently at Lakeland High School?

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* 17. Why would you recommend Journey?

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