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Instructions

Do you love going on the Internet, watching TV, playing video games, or listening to music? Most everyone does! This survey is going to ask about how you use media and what types of media you like the most.

Since your name is not on the survey, no one will know how you answer--so you can be honest! Your honesty will help us!

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* 1. What grade are you in?

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* 2. What is your gender?

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* 3. Do you have older siblings?

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* 4. What kind of media do you have at home? Check the box for each thing that you have.

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* 5. Computers...

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* 6. Do you need to ask permission to use the computer or go online?

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* 7. Do you have your own personal email account?

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* 8. Have you ever created a personal website, blog or wiki?

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* 9. Do your parents know about your online activity?

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* 10. Do you have your own cell phone?

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* 11. What's your favorite MOVIE?

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* 12. What's your favorite WEBSITE?

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* 13. What's your favorite MUSICIAN/BAND?

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* 14. What's your favorite VIDEO GAME?

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* 15. Do you play video games ONLINE or with your XBox/Nintendo/Wii/Connect/Playstation?

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* 16. Have you ever chatted with anyone online while gaming?

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* 17. What's your favorite TV SHOW?

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* 18. What's your favorite BOOK?

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* 19. On a typical SCHOOL DAY (Monday-Friday), how many hours do you spend doing each of these things? If you never do something, check the box under the zero.

  0 1 2 3 4 5+
watching TV, movies or DVD's
Listening to music on a mobile device (iPod, MP3 player)
Playing video games on a colnsole or mobile device
Using a cell phone for communicating (talking or texting)
Using the Internet for entertainment and socializing
Using the Internet for homework or school
Reading magazines or books for entertainment (not for school)

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* 20. If you use the Internet, which of these things do you do online at least once a week? Check the box next to each thing you do.

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* 21. Have you done any of these things when using the Internet or your cell phone?

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* 22. Do you have a profile on a social networking site (Facebook, MySpace, a social gaming site)?

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* 23. If you have a Facebook account, do your parents look at it? If you don't have one, don't answer the question.

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* 24. Have your parents talked with you about any of these things in the past year or so? Answer yes or no.

  yes no
Which types of media I'm allowed to use
How much time I'm allowed to use media or devices like a cell phone or video game
What media means or what its messages are
Not sharing my passwords or personal information online
Cyberbullying
Downloading songs or movies illegally
What's ok to post online (photos, videos, comments, etc)
using media to cheat on school work
How people or information online might not be trustworthy
How online content can be copied and pasted and used in ways I might not intend

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* 25. If you answered "NO" to any of the statements in the last question: Why do you think they haven't talked with you about those things?

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* 26. What is your definition of cyberbullying?

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* 27. Have you ever experienced cyberbullying (directed at you)?

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* 28. Are you aware of a friend or a classmate who has been bullied online?

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* 29. Do you have any questions?

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* 30. Is there anything you would like for us to know?

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