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* 1. While you may have celebrated your birthday on different days with different people, please think about the one single day (and night) that you consider your main 21st birthday celebration day.

Please use the chart above when calculating number of drinks.

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* 2. How many alcoholic beverages did you consume while celebrating your 21st birthday? (If you did not drink, enter 0)

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* 3. Over how many HOURS did you drink alcohol while celebrating your 21st birthday? (If you did not drink, SKIP this question)

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* 4. While celebrating my 21st birthday, I:

	Yes	No
Alternated alcoholic with non-alcoholic beverages/water	Alternated alcoholic with non-alcoholic beverages/water Yes	Alternated alcoholic with non-alcoholic beverages/water No
Asked a friend to let me know when I had enough	Asked a friend to let me know when I had enough Yes	Asked a friend to let me know when I had enough No
Determined, in advance, not to exceed a set number of drinks	Determined, in advance, not to exceed a set number of drinks Yes	Determined, in advance, not to exceed a set number of drinks No
Ate before and/or while drinking	Ate before and/or while drinking Yes	Ate before and/or while drinking No
Kept track of how many drinks I had	Kept track of how many drinks I had Yes	Kept track of how many drinks I had No
Made my drinks or watched them being made	Made my drinks or watched them being made Yes	Made my drinks or watched them being made No
Paced my drinks to one or fewer per hour	Paced my drinks to one or fewer per hour Yes	Paced my drinks to one or fewer per hour No
Stayed in a group (the “buddy system”)	Stayed in a group (the “buddy system”) Yes	Stayed in a group (the “buddy system”) No
Used a designated driver or made other plans to get home safely	Used a designated driver or made other plans to get home safely Yes	Used a designated driver or made other plans to get home safely No

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* 5. As a result of my 21st birthday celebration, I experienced the following:

	Yes	No
Lost my belongings	Lost my belongings Yes	Lost my belongings No
Drunk texted/dialed	Drunk texted/dialed Yes	Drunk texted/dialed No
Behaved in ways I regret	Behaved in ways I regret Yes	Behaved in ways I regret No
Vomited	Vomited Yes	Vomited No
Physically injured myself	Physically injured myself Yes	Physically injured myself No
Physically injured another person	Physically injured another person Yes	Physically injured another person No
Got into a physical/verbal fight	Got into a physical/verbal fight Yes	Got into a physical/verbal fight No
Got in trouble with the police	Got in trouble with the police Yes	Got in trouble with the police No
Any memory loss	Any memory loss Yes	Any memory loss No
Engaged in consensual sexual activity without safer-sex practices that I usually use	Engaged in consensual sexual activity without safer-sex practices that I usually use Yes	Engaged in consensual sexual activity without safer-sex practices that I usually use No
Other (please describe below)	Other (please describe below) Yes	Other (please describe below) No

List "other" response here

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* 6. How many drinks do you think typical U.Va. students consume during their 21st birthday celebrations?

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* 7. Please indicate the percent of students who you think drank (LESS than, the SAME as, or MORE than) you during their 21st birthday celebrations. The three answers should total 100%

	0%	10%	20%	30%	40%	50%	60%	70%	80%	90%	100%
Percent who drank LESS than you	Percent who drank LESS than you 0%	Percent who drank LESS than you 10%	Percent who drank LESS than you 20%	Percent who drank LESS than you 30%	Percent who drank LESS than you 40%	Percent who drank LESS than you 50%	Percent who drank LESS than you 60%	Percent who drank LESS than you 70%	Percent who drank LESS than you 80%	Percent who drank LESS than you 90%	Percent who drank LESS than you 100%
Percent who drank the SAME as you	Percent who drank the SAME as you 0%	Percent who drank the SAME as you 10%	Percent who drank the SAME as you 20%	Percent who drank the SAME as you 30%	Percent who drank the SAME as you 40%	Percent who drank the SAME as you 50%	Percent who drank the SAME as you 60%	Percent who drank the SAME as you 70%	Percent who drank the SAME as you 80%	Percent who drank the SAME as you 90%	Percent who drank the SAME as you 100%
Percent who drank MORE than you	Percent who drank MORE than you 0%	Percent who drank MORE than you 10%	Percent who drank MORE than you 20%	Percent who drank MORE than you 30%	Percent who drank MORE than you 40%	Percent who drank MORE than you 50%	Percent who drank MORE than you 60%	Percent who drank MORE than you 70%	Percent who drank MORE than you 80%	Percent who drank MORE than you 90%	Percent who drank MORE than you 100%

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* 8. Before your 21st birthday, how many alcoholic DRINKS did you consume on a typical night out? (If you did not drink before you turned 21, enter 0)

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* 9. Before your 21st birthday, over how many HOURS did you drink on a typical night out? (If you did not drink before you turned 21, enter 0)

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* 10. What is your biological sex?

Female

Male

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* 11. What is your approximate weight in pounds? (To be used ONLY to estimate Blood Alcohol Content - BAC)

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* 12. Are you a member of any of the following?

	Yes	No
IFC or ISC fraternity or sorority	IFC or ISC fraternity or sorority Yes	IFC or ISC fraternity or sorority No
MGC or NPHC fraternity or sorority	MGC or NPHC fraternity or sorority Yes	MGC or NPHC fraternity or sorority No
UVA athletics team OR club sport that travels to compete	UVA athletics team OR club sport that travels to compete Yes	UVA athletics team OR club sport that travels to compete No

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* 13. Please provide any comments here

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