Know the Truth Student Survey
1) Your School Name:
2) Your Age:
3) Gender you most identify with:
4) Your Race or Ethnicity
American Indian/Alaska Native
5) Have you ever used Tobacco/Nicotine product?
What form have you used? *Please mark all that apply.
During the last 30 days, how many days did you use tobacco/nicotine products?
6) Have you ever drank alcohol?
During the last 30 days, how many days did you have 4 or more drink?
7) Have you ever taken prescription pills that were not prescribed to you?
What did you take? *Please mark all that apply.
Benzo (Xanax, Valium, Klonopin, Ativan)
During the last 30 days, how many days did you take prescription drugs that were not prescribed for you?
8) Have you ever used Marijuana (pot,weed,hash)?
What form? *Please mark all that apply.
9) Have you ever used any of the following? *Please mark all that apply.
Synthetics (K-2, Bath Salts)
Hallucinogens (LSD/Acid, Mushrooms)
Ecstasy (MDMA, Molly)
10) How much do you think people risk harming themselves physically or in other ways if they choose to use drugs and alcohol?
11) What do you think are the main reasons people choose not to use?
Physical/Mental harm drugs cause
I don't want to get in trouble or have legal problems
I don't have reasons for not using
12) Where do you get most of your information about drugs and alcohol?
13) Do you plan to use nicotine before you turn 18?
14) After hearing todays presentation, do you plan on using illegal drugs in the future?
15) Do you plan on drinking alcohol before you turn 21?
16) What is something impactful that you learned or took away from this presentation?