Survey- "About Me"

What's your gender?

• Male
• Female

How old are you?

• under 13
• 13-15
• 16-18
• 19-25
• over 25

What is your education level?

• Attending elementary school
• Attending middle school
• Attending high school
• High school graduate or GED
• Attending college or work school
• College degree, no longer in school
• Other

What do you like to do in your spare time (when alone)?

Please select all that apply.

• Read
• Draw
• Write (poetry, stories, songs, etc)
• Listen to music
• Video games
• Watch television
• Computer
• Other

What sort of music do you listen to on a regular basis?

Please select all that apply.

• Rock (classic, gothic, emo, screamo, alternative, symphonic, or hard)
• Metal (gothic, alternative, symphonic, or heavy)
• Hip-hop
• Rap
• Pop
• Country
• Religious
• Classical
• Other
• All of the above

What's your se.xual orientation?

• Heterose.xual (straight)
• Homose.xual (lesbian, gay)
• Bisexual
• Asexual
• Other
• Unsure

What's your religious orientation?

• Christian (Protestant, Catholic, Mormon, etc)
• Jewish
• Muslim
• Atheist
• Neo-Pagan (Wicca, Druid, Shaman, etc)
• Buddist
• Agnostic
• Other
• Still searching

Do you do drugs? (other than alcohol or tobacco)

• Yes
• Yes. I want to quit.
• Sometimes, rarely.
• I used to.
• No.

Do you drink?

• Yes.
• Yes. I want to quit.
• Sometimes, rarely.
• I used to.
• No.

Do you use tobacco?

• Yes.
• Yes. I want to quit.
• Sometimes, rarely.
• I used to.
• No.

Do you self-harm?

• Yes.
• Yes. Trying to quit.
• I used to.
• No.

How many siblings do you have? (who used to or currently live with you)

• None
• 1
• 2
• 3
• 4 or more

Are your parents...?

• Married
• Separated or divorced
• Single mother
• Widowed parent
• Other