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1. 
Classification:
 
Freshman
 
Sophomore
 
Junior
 
Senior
 
Graduate/Professional
 
Non-degree seeking
 
Other
 
 
2. 
Gender:
 
Male
 
Female

 
 
3. 
Age:
 
17
 
18
 
19
 
20
 
21
 
22
 
23
 
24

 
 
4. 
Ethnic origin:
 
American Indian/Alaskan Native
 
Hispanic
 
Asian/Pacific Islander
 
White (non-hispanic)
 
Black (non-hispanic)
 
Other

 
 
5. 
Are you employed?
 
Yes, Full-time
 
Yes, Part-time
 
No

 
 
6. 
Where do you live?
 
Off campus
 
Residence Hall
 
Fraternity/Sorority
 
Other

 
 
7. 
Who do you live with?
 
Roommate (also college student)
 
Roommate (not college student)
 
Alone
 
Parent(s)
 
Spouse
 
Children
 
Other

 
 
8. 
Student Status:
 
Full-time (12+ credits undergrad/ 9+ grad)
 
Part-time (less than 12/ less than 9)

 
 
9. 
In the last two weeks, how many times have you had five or more drinks? (a drink is considered a bottle of beer, glass of wine, shot of liquor)
 
None
 
Once
 
Twice
 
3-5 times
 
6-9 times
 
10 or more times

 
 
10. 
Average number of drinks you consume a week:
 
None
 
1-5
 
5-10
 
10-20
 
20-30
 
30+

 
 
11. At what age did you first use...
Never used Under 10 10-11 12-13 14-15 16-17 18-19 20-21 22-24
Tobacco
Alcohol
Marijuana
Cocaine
Amphetamines
Sedatives
Hallucinogens
Opiates
Inhalants
Ecstacy/MDMA
Steriods
Other illegal drugs
 
 
12. Within the last year about how often have you used...
Never Once/year 6 times/year Once/month Twice/mouth Once/week 3 times/week 5 times/week Every day
Tobacco
Alcohol
Marijuana
Cocaine
Amphetamines
Sedatives
Hallucinogens
Optiates
Inhalants
Ecstacy/MDMA
Steriods
Other illegal drugs
 
 
13. How often do you think the average student on camups uses...
Never Once/year 6 times/year Once/month Twice/month Once/week 3 times/week 5 times/week Every day
Tobacco
Alcohol
Marijuana
Cocaine
Amphetamines
Sedatives
Hallucinogens
Optiates
Inhalants
Ecstacy/MDMA
Steroids
Other illegal drugs
 
 
14. During the past 30 days on how many days did you have:
0 days 1-2 days 3-5 days 6-9 days 10-19 days 20-29 days Every day
Tobacco
Alcohol
Marijuana
Cocaine
Amphetamines
Sedatives
Hallucinogens
Optiates
Inhalants
Ecstacy/MDMA
Steroids
Other illegal drugs
 
 
15. How often have you experienced the following due to your drinking and/or drug use during the last year...
Never Once Twice 3-5 times 6-9 times 10 or more times
Had a hangover
Performed poorly on an exam/project
Gotten into trouble (police, school, ect.)
Damaged property
Got into a physical fight
Vomitted
Driven a car/ bike under the influence
Missed a class
Experienced loss of memory
Done something you regretted
Have been taken advantage of sexually
Been hurt or injured
 
 
 
16. Within the last year what was your involvement inthe following activities?
Not involved Attended Involved (non-leader) Involved (leader)
Intercollegiate athletics
Intramural sports
Fraternities/Sororities
Relgious groups
International/language groups
Minority/Ethnic organizations
Political groups
Performing arts
Student media (newspaper, radio, ect.)
 
 
 
17. Do you think alcohol has the following effects?
Yes No
Breaks the ice
Enhances social activity
Makes coping with stress easier
Gives people something to talk about
Allows people to have fun
Gives people something to do
Makes food taste better
Makes people sexier
Facilitates sexual opprotunities
 
 
18. On campus, do you believe drinking is central to the following social groups?
Yes No
Male Students
Female Students
Faculty/Staff
Alumni
Athletes
Fraternities
Sororities
 
 
19. 
What is your grade point average?
 
4.0
 
3.5-3.99
 
3.0-3.49
 
2.5-2.99
 
2.0-2.49
 
1.5-1.99
 
1.0-1.49
 
0.0-.99
 
 
20. When you are at the following places, how many drinks do you typcially have?
None 1-4 drinks 5-10 drinks 10+ drinks
Out do dinner
At a party (where alcohol is being served)
At a club/bar
 
 
21. 
Compared to other campuses in which you are familar, your campus' use of alcohol is...
 
Greater than other campuses
 
About the same
 
Less than other campuses
 
 
 
Do you have any suggestions about how your school can help students become more aware of the dangers of drugs? Any policies you feel should be inacted?
   
 
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