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What is your grade level?
 
6th
 
7th
 
8th
 
9th
 
10th
 
11th
 
12th
 
 
 
What is your gender?
 
Male
 
Female
 
 
 
What time do you usually get home from school?
 
3:00-4:00
 
4:00-5:00
 
5:00-6:00
 
6:00-7:00
 
7:00 or later
 
 
 
What is your average bedtime?
 
8:00-9:00
 
9:00-10:00
 
10:00-11:00
 
11:00-12:00
 
12:00 or later
 
 
 
What was your average GPA of last year?
 
90-100
 
80-89
 
70-79
 
69 or lower
 
 
 
Do you play sports?
 
Yes
 
No
 
 
 
If you answered yes to previous question
How long is your practice?
 
1 hour
 
2 hours
 
3 hours
 
4 hours or longer
 
 
 
Do you have a job?
 
Yes
 
No
 
 
 
If you answered yes to previous question
How long are you there for?
 
1 hour
 
2 hours
 
3 hours
 
4 hours or longer
 
 
 
What do you enjoy doing in your leisure?
Choose all that apply.
 
Eating
 
Sleeping
 
Using Electronics
 
Spending time with friends
 
Spending time with family
 
Exercising
 
Other
 
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