This survey is about health behavior. It has been developed so you can tell us what you do that may
affect your health. The information you give will be used to improve health education for young people like yourself.
The answers you give will be kept private. No one will know what you write or select. Answer the questions based on what you really do.
Completing the survey is voluntary. Whether or not you answer the questions will not affect your grade in this class. If you are not comfortable answering a question, just leave it blank.
The questions that ask about your background will be used only to describe the types of students completing this survey. The information will not be used to find out your name. No names will ever be reported.
Make sure to read every question. When you are finished, follow the instructions of the person giving you the survey.
*Some of the questions ask you to think about how you feel and what you have experienced. If any questions bring up issues that you would like to talk about with an adult in private, there are school staff (counselor, social worker, psychologist) who would be glad to talk with you.
You can also call the Niagara County Crisis Hotline at 716-285-3515
Or text “HOME” or “Got5” to the National Crisis Text Line at 741741
Thank you very much for your help.