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Hello:
You are invited to participate in our survey [Life Skills Training Questionnaire Middle School Level 1]. In this survey, all middle school students 6th through 8th grade  at Shaffer Elementary will be asked to complete a survey that asks questions about Health knowledge, attitudes, and behaviors]. It will take approximately 30 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 Behavioral Health at 530-251-2631 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.
 
 
 
 
* Date
MonthDayYear
  
 
 
 
* Student Code#
   
 
 
 
* Data Collection Point
 
Pretest
 
Post Test
 
Followup
 
 
 
What is your date of birth?
MonthDayYear
  
 
 
 
Are you
 
Male
 
Female
 
 
 
Who do you live with most of the time?
 
Mother and Father
 
Only Mother
 
Mother and Stepfather
 
Only Father
 
Stepmother and Father
 
Some with Mother/Some with Father
 
Other Relative
 
Guardian or Foster Parent
 
Alone or with friends
 
Other
 
 
 
 
Are you Hispanic or Latino
 
Yes
 
No
 
 
 
What is your race? 
 
American Indian/Alaska Native
 
Asian
 
Native Hawaiian or other Pacific Islander
 
Black or African American
 
White
 
Other
 
 
 
 
What grade are you in
 
6th
 
7th
 
8th
 
9th
 
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