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Hello:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
 
How old are you?
 
 
 
Please choose your grade level.
 
Freshman
 
Sophomore
 
Junior
 
Senior
 
 
 
Please choose your gender.
 
Male
 
Female
 
 
 
In the last month have you:
 
Drank any alcohol
 
Bringe(consuming four or more drinks in 2 hours or less)
 
Driven under the influence of alcohol
 
Ridden with a driver who was under the influence of alcohol

 
 
 
Have your ever:
 
Drank any alcohol
 
Bringe(consuming four or more drinks in 2 hours or less)
 
Driven under the influence of alcohol
 
Ridden with a driver who was under the influence of alcohol

 
 
 
In the last month have you used:
 
Marijuana
 
Cocaine
 
Heroin
 
Prescription drugs that were not yours
 
None
 
Other
 

 
 
 
Have you ever used:
 
Marijuana
 
Cocaine
 
Heroin
 
Prescription drugs that were not yours
 
None
 
Other
 

 
 
 
Have you ever been offered?
 
Alcohol
 
Drugs
 
Tobacco

 
 
 
Thank your for partcipation.