Form approved
OMB Control No: 0970-0536
Expiration Date: 12/31/2023

Sexual Risk Avoidance Education (SRAE)

High School
Participant EXIT Survey

THE PAPERWORK REDUCTION ACT OF 1995

Public reporting burden for this collection of information is estimated to average 8 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The information collected will help policy makers, program providers and other stakeholders understand the experiences of youth today and identify ways to reduce risky behaviors. This information also will inform programs on how best to serve their participants. The collection of this information is voluntary, and responses will be kept private to the extent allowed by law. The OMB number for this information collection is 0970-0536 and the expiration date is 12/31/2023.

Thank you for your help with this important study. This survey includes questions about your family, friends, school, and also your attitudes and behaviors. Your name will not be on the survey and your responses will remain private to the extent permitted by law. We want you to know that:

1. Your participation in the survey is voluntary.

2. We hope that you will answer all of the questions, but you may skip any questions you do not wish to answer.

3. The answers you give will be kept private to the extent permitted by law.

PLEASE READ EACH QUESTION CAREFULLY: There are different ways to answer the questions in this survey. It is important that you follow the instructions when answering each kind of question.

Question Title

* I understand and agree that completing this survey is voluntary.

Yes

Please answer the following questions as best you can. This first set of questions are about you.

Question Title

* 1. How old are you?
Mark only one answer.

20 or older

Question Title

* 2. What grade are you in? (If you are currently on vacation or in summer school, indicate the grade you will be in when you go back to school.)
Mark only one answer.

4th

5th

6th

7th

8th

9th

10th

11th

12th

My school does not assign grade levels.

I dropped out of school, and I am not working on getting a high school diploma or GED.

I am working toward a GED.

I have a high school diploma or GED, but I am not currently enrolled in college or technical school.

I have a high school diploma or GED and I am currently enrolled in college or technical school.

Question Title

* 3. When you are at home or with your family, what language or languages do you usually speak?
Mark all that apply.

English

Spanish

Other (please specify)

Question Title

* 4. Are you Hispanic or Latino?
Mark only one answer.

Yes

Question Title

* 5. What is your race?
Mark all that apply.

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White or Caucasian

Question Title

* 6. What is your sex?
Mark only one answer.

Male

Female

Question Title

* 7. Are you currently ...?
Mark all that apply.

In foster care, living with a family.

In foster care, living in a group home.

Couch surfing or moving from home to home.

Living in a place not meant to be a residence, such as outside, in a tent city or homeless camp, in a car, in an abandoned vehicle or in an abandoned building.

Staying in an emergency shelter or transitional living program.

Staying in a hotel or motel.

In juvenile detention, jail, prison or another correctional facility, or under the supervision of a probation officer.

None of the above.

For questions 8-12, please think about how the program you just completed has affected you, even if your program did not cover the topic.

Question Title

* 8. Has being in the program made you more likely, about the same, or less likely to...
(Note: If the program has not affected your likelihood to do any of the following, choose "About the same.")
Mark only one answer per row.

	Much more likely	Somewhat more likely	About the same	Somewhat less likely	Much less likely
8a. make decisions to not drink alcohol?	8a. make decisions to not drink alcohol? Much more likely	8a. make decisions to not drink alcohol? Somewhat more likely	8a. make decisions to not drink alcohol? About the same	8a. make decisions to not drink alcohol? Somewhat less likely	8a. make decisions to not drink alcohol? Much less likely
8b. make decisions to not smoke cigarettes?	8b. make decisions to not smoke cigarettes? Much more likely	8b. make decisions to not smoke cigarettes? Somewhat more likely	8b. make decisions to not smoke cigarettes? About the same	8b. make decisions to not smoke cigarettes? Somewhat less likely	8b. make decisions to not smoke cigarettes? Much less likely
8c. make decisions to not smoke cigars, cigarillos, or little cigars?	8c. make decisions to not smoke cigars, cigarillos, or little cigars? Much more likely	8c. make decisions to not smoke cigars, cigarillos, or little cigars? Somewhat more likely	8c. make decisions to not smoke cigars, cigarillos, or little cigars? About the same	8c. make decisions to not smoke cigars, cigarillos, or little cigars? Somewhat less likely	8c. make decisions to not smoke cigars, cigarillos, or little cigars? Much less likely
8d. make decisions to not use other tobacco products (such as chewing tobacco, snuff, dip, or snus)?	8d. make decisions to not use other tobacco products (such as chewing tobacco, snuff, dip, or snus)? Much more likely	8d. make decisions to not use other tobacco products (such as chewing tobacco, snuff, dip, or snus)? Somewhat more likely	8d. make decisions to not use other tobacco products (such as chewing tobacco, snuff, dip, or snus)? About the same	8d. make decisions to not use other tobacco products (such as chewing tobacco, snuff, dip, or snus)? Somewhat less likely	8d. make decisions to not use other tobacco products (such as chewing tobacco, snuff, dip, or snus)? Much less likely
8e. make decisions to not use electronic vapor products (such as JUUL, Vuse, MarkTen, and blu)? (electronic vapor products include e-cigarettes, vapes, vape pens, e-cigars, hookahs, hookah pens, and mods)	8e. make decisions to not use electronic vapor products (such as JUUL, Vuse, MarkTen, and blu)? (electronic vapor products include e-cigarettes, vapes, vape pens, e-cigars, hookahs, hookah pens, and mods) Much more likely	8e. make decisions to not use electronic vapor products (such as JUUL, Vuse, MarkTen, and blu)? (electronic vapor products include e-cigarettes, vapes, vape pens, e-cigars, hookahs, hookah pens, and mods) Somewhat more likely	8e. make decisions to not use electronic vapor products (such as JUUL, Vuse, MarkTen, and blu)? (electronic vapor products include e-cigarettes, vapes, vape pens, e-cigars, hookahs, hookah pens, and mods) About the same	8e. make decisions to not use electronic vapor products (such as JUUL, Vuse, MarkTen, and blu)? (electronic vapor products include e-cigarettes, vapes, vape pens, e-cigars, hookahs, hookah pens, and mods) Somewhat less likely	8e. make decisions to not use electronic vapor products (such as JUUL, Vuse, MarkTen, and blu)? (electronic vapor products include e-cigarettes, vapes, vape pens, e-cigars, hookahs, hookah pens, and mods) Much less likely
8f. make decisions to not use marijuana (also called pot, weed, or cannabis)?	8f. make decisions to not use marijuana (also called pot, weed, or cannabis)? Much more likely	8f. make decisions to not use marijuana (also called pot, weed, or cannabis)? Somewhat more likely	8f. make decisions to not use marijuana (also called pot, weed, or cannabis)? About the same	8f. make decisions to not use marijuana (also called pot, weed, or cannabis)? Somewhat less likely	8f. make decisions to not use marijuana (also called pot, weed, or cannabis)? Much less likely
8g. make decisions to not take prescription pain medication without a doctor's prescription or differently than how a doctor told you to use it?	8g. make decisions to not take prescription pain medication without a doctor's prescription or differently than how a doctor told you to use it? Much more likely	8g. make decisions to not take prescription pain medication without a doctor's prescription or differently than how a doctor told you to use it? Somewhat more likely	8g. make decisions to not take prescription pain medication without a doctor's prescription or differently than how a doctor told you to use it? About the same	8g. make decisions to not take prescription pain medication without a doctor's prescription or differently than how a doctor told you to use it? Somewhat less likely	8g. make decisions to not take prescription pain medication without a doctor's prescription or differently than how a doctor told you to use it? Much less likely

Question Title

* 9. Has being in the program made you more likely, about the same, or less likely to...
(Note: If the program has not affected your likelihood to do the following, choose "About the same.")
Mark only one answer per row.

	Much more likely	Somewhat more likely	About the same	Somewhat less likely	Much less likely
9a. resist or say no to peer pressure?	9a. resist or say no to peer pressure? Much more likely	9a. resist or say no to peer pressure? Somewhat more likely	9a. resist or say no to peer pressure? About the same	9a. resist or say no to peer pressure? Somewhat less likely	9a. resist or say no to peer pressure? Much less likely
9b. manage your emotions in healthy ways (for example, ways that are not hurtful to your or others)?	9b. manage your emotions in healthy ways (for example, ways that are not hurtful to your or others)? Much more likely	9b. manage your emotions in healthy ways (for example, ways that are not hurtful to your or others)? Somewhat more likely	9b. manage your emotions in healthy ways (for example, ways that are not hurtful to your or others)? About the same	9b. manage your emotions in healthy ways (for example, ways that are not hurtful to your or others)? Somewhat less likely	9b. manage your emotions in healthy ways (for example, ways that are not hurtful to your or others)? Much less likely
9c. worked together to find a solution when you disagree with a friend?	9c. worked together to find a solution when you disagree with a friend? Much more likely	9c. worked together to find a solution when you disagree with a friend? Somewhat more likely	9c. worked together to find a solution when you disagree with a friend? About the same	9c. worked together to find a solution when you disagree with a friend? Somewhat less likely	9c. worked together to find a solution when you disagree with a friend? Much less likely
9d. choose to spend time with friends that keep you out of trouble?	9d. choose to spend time with friends that keep you out of trouble? Much more likely	9d. choose to spend time with friends that keep you out of trouble? Somewhat more likely	9d. choose to spend time with friends that keep you out of trouble? About the same	9d. choose to spend time with friends that keep you out of trouble? Somewhat less likely	9d. choose to spend time with friends that keep you out of trouble? Much less likely
9e. be respectful of others?	9e. be respectful of others? Much more likely	9e. be respectful of others? Somewhat more likely	9e. be respectful of others? About the same	9e. be respectful of others? Somewhat less likely	9e. be respectful of others? Much less likely
9f. think about the consequences before making a decision?	9f. think about the consequences before making a decision? Much more likely	9f. think about the consequences before making a decision? Somewhat more likely	9f. think about the consequences before making a decision? About the same	9f. think about the consequences before making a decision? Somewhat less likely	9f. think about the consequences before making a decision? Much less likely

Question Title

* 10. Has being in the program made you more likely, about the same, or less likely to...
(Note: If the program has not affected your likelihood to do the following, choose "About the same.")
Mark only one answer per row.

	Much more likely	Somewhat more likely	About the same	Somewhat less likely	Much less likely
10a. make plans to reach your goals?	10a. make plans to reach your goals? Much more likely	10a. make plans to reach your goals? Somewhat more likely	10a. make plans to reach your goals? About the same	10a. make plans to reach your goals? Somewhat less likely	10a. make plans to reach your goals? Much less likely
10b. care about doing well in school?	10b. care about doing well in school? Much more likely	10b. care about doing well in school? Somewhat more likely	10b. care about doing well in school? About the same	10b. care about doing well in school? Somewhat less likely	10b. care about doing well in school? Much less likely
10c. save money to get things you want?	10c. save money to get things you want? Much more likely	10c. save money to get things you want? Somewhat more likely	10c. save money to get things you want? About the same	10c. save money to get things you want? Somewhat less likely	10c. save money to get things you want? Much less likely
10d. graduate high school or get your GED?	10d. graduate high school or get your GED? Much more likely	10d. graduate high school or get your GED? Somewhat more likely	10d. graduate high school or get your GED? About the same	10d. graduate high school or get your GED? Somewhat less likely	10d. graduate high school or get your GED? Much less likely
10e. get more education or training after high school or completing your GED?	10e. get more education or training after high school or completing your GED? Much more likely	10e. get more education or training after high school or completing your GED? Somewhat more likely	10e. get more education or training after high school or completing your GED? About the same	10e. get more education or training after high school or completing your GED? Somewhat less likely	10e. get more education or training after high school or completing your GED? Much less likely
10f. get a steady full-time job after school?	10f. get a steady full-time job after school? Much more likely	10f. get a steady full-time job after school? Somewhat more likely	10f. get a steady full-time job after school? About the same	10f. get a steady full-time job after school? Somewhat less likely	10f. get a steady full-time job after school? Much less likely
10g. feel comfortable talking with your parent, guardian, or caretaker about sex?	10g. feel comfortable talking with your parent, guardian, or caretaker about sex? Much more likely	10g. feel comfortable talking with your parent, guardian, or caretaker about sex? Somewhat more likely	10g. feel comfortable talking with your parent, guardian, or caretaker about sex? About the same	10g. feel comfortable talking with your parent, guardian, or caretaker about sex? Somewhat less likely	10g. feel comfortable talking with your parent, guardian, or caretaker about sex? Much less likely
10h. speak up or ask for help if you are being bullied in person or online, via text, while gaming, or through other social media.	10h. speak up or ask for help if you are being bullied in person or online, via text, while gaming, or through other social media. Much more likely	10h. speak up or ask for help if you are being bullied in person or online, via text, while gaming, or through other social media. Somewhat more likely	10h. speak up or ask for help if you are being bullied in person or online, via text, while gaming, or through other social media. About the same	10h. speak up or ask for help if you are being bullied in person or online, via text, while gaming, or through other social media. Somewhat less likely	10h. speak up or ask for help if you are being bullied in person or online, via text, while gaming, or through other social media. Much less likely
10i. speak up or ask for help if others are being bullied in person or online, via text, while gaming, or through other social media.	10i. speak up or ask for help if others are being bullied in person or online, via text, while gaming, or through other social media. Much more likely	10i. speak up or ask for help if others are being bullied in person or online, via text, while gaming, or through other social media. Somewhat more likely	10i. speak up or ask for help if others are being bullied in person or online, via text, while gaming, or through other social media. About the same	10i. speak up or ask for help if others are being bullied in person or online, via text, while gaming, or through other social media. Somewhat less likely	10i. speak up or ask for help if others are being bullied in person or online, via text, while gaming, or through other social media. Much less likely

Question Title

* 11. Has being in the program made you more likely, about the same, or less likely to...
(Note: If the program has not affected your likelihood to do the following, choose "About the same.")
Mark only one answer per row.

	Much more likely	Somewhat more likely	About the same	Somewhat less likely	Much less likely
11a. better understand what makes a relationship healthy?	11a. better understand what makes a relationship healthy? Much more likely	11a. better understand what makes a relationship healthy? Somewhat more likely	11a. better understand what makes a relationship healthy? About the same	11a. better understand what makes a relationship healthy? Somewhat less likely	11a. better understand what makes a relationship healthy? Much less likely
11b. look for information and resources about dating violence (for example, websites, social media, hotlines, organizations, etc.)?	11b. look for information and resources about dating violence (for example, websites, social media, hotlines, organizations, etc.)? Much more likely	11b. look for information and resources about dating violence (for example, websites, social media, hotlines, organizations, etc.)? Somewhat more likely	11b. look for information and resources about dating violence (for example, websites, social media, hotlines, organizations, etc.)? About the same	11b. look for information and resources about dating violence (for example, websites, social media, hotlines, organizations, etc.)? Somewhat less likely	11b. look for information and resources about dating violence (for example, websites, social media, hotlines, organizations, etc.)? Much less likely
11c. resist or say no to someone you are dating or going out with if they pressured you to participate in sexual acts, such as kissing, touching private parts, or sexual intercourse?	11c. resist or say no to someone you are dating or going out with if they pressured you to participate in sexual acts, such as kissing, touching private parts, or sexual intercourse? Much more likely	11c. resist or say no to someone you are dating or going out with if they pressured you to participate in sexual acts, such as kissing, touching private parts, or sexual intercourse? Somewhat more likely	11c. resist or say no to someone you are dating or going out with if they pressured you to participate in sexual acts, such as kissing, touching private parts, or sexual intercourse? About the same	11c. resist or say no to someone you are dating or going out with if they pressured you to participate in sexual acts, such as kissing, touching private parts, or sexual intercourse? Somewhat less likely	11c. resist or say no to someone you are dating or going out with if they pressured you to participate in sexual acts, such as kissing, touching private parts, or sexual intercourse? Much less likely
11d. talk to a friend if someone you are dating or going out with makes you uncomfortable, hurts me, or pressures you to do things you don't want to do?	11d. talk to a friend if someone you are dating or going out with makes you uncomfortable, hurts me, or pressures you to do things you don't want to do? Much more likely	11d. talk to a friend if someone you are dating or going out with makes you uncomfortable, hurts me, or pressures you to do things you don't want to do? Somewhat more likely	11d. talk to a friend if someone you are dating or going out with makes you uncomfortable, hurts me, or pressures you to do things you don't want to do? About the same	11d. talk to a friend if someone you are dating or going out with makes you uncomfortable, hurts me, or pressures you to do things you don't want to do? Somewhat less likely	11d. talk to a friend if someone you are dating or going out with makes you uncomfortable, hurts me, or pressures you to do things you don't want to do? Much less likely
11e. talk to a trusted adult (for example, a family member, teacher, counselor, coach, etc.) if someone you are dating or going out with makes you uncomfortable, hurts you, or pressures me you do things you don't want to do?	11e. talk to a trusted adult (for example, a family member, teacher, counselor, coach, etc.) if someone you are dating or going out with makes you uncomfortable, hurts you, or pressures me you do things you don't want to do? Much more likely	11e. talk to a trusted adult (for example, a family member, teacher, counselor, coach, etc.) if someone you are dating or going out with makes you uncomfortable, hurts you, or pressures me you do things you don't want to do? Somewhat more likely	11e. talk to a trusted adult (for example, a family member, teacher, counselor, coach, etc.) if someone you are dating or going out with makes you uncomfortable, hurts you, or pressures me you do things you don't want to do? About the same	11e. talk to a trusted adult (for example, a family member, teacher, counselor, coach, etc.) if someone you are dating or going out with makes you uncomfortable, hurts you, or pressures me you do things you don't want to do? Somewhat less likely	11e. talk to a trusted adult (for example, a family member, teacher, counselor, coach, etc.) if someone you are dating or going out with makes you uncomfortable, hurts you, or pressures me you do things you don't want to do? Much less likely
11f. talk to a trusted adult if someone other than the person you are dating or going out with makes you feel uncomfortable, hurts you, or pressures you to do things you don't want to do?	11f. talk to a trusted adult if someone other than the person you are dating or going out with makes you feel uncomfortable, hurts you, or pressures you to do things you don't want to do? Much more likely	11f. talk to a trusted adult if someone other than the person you are dating or going out with makes you feel uncomfortable, hurts you, or pressures you to do things you don't want to do? Somewhat more likely	11f. talk to a trusted adult if someone other than the person you are dating or going out with makes you feel uncomfortable, hurts you, or pressures you to do things you don't want to do? About the same	11f. talk to a trusted adult if someone other than the person you are dating or going out with makes you feel uncomfortable, hurts you, or pressures you to do things you don't want to do? Somewhat less likely	11f. talk to a trusted adult if someone other than the person you are dating or going out with makes you feel uncomfortable, hurts you, or pressures you to do things you don't want to do? Much less likely

Question Title

* 12. Has being in the program made you more likely, about the same, or less likely to...
Mark only one answer per row.

	Much more likely	Somewhat more likely	About the same	Somewhat less likely	Much less likely
12a. plan to delay having sexual intercourse until you graduate high school or receive your GED.	12a. plan to delay having sexual intercourse until you graduate high school or receive your GED. Much more likely	12a. plan to delay having sexual intercourse until you graduate high school or receive your GED. Somewhat more likely	12a. plan to delay having sexual intercourse until you graduate high school or receive your GED. About the same	12a. plan to delay having sexual intercourse until you graduate high school or receive your GED. Somewhat less likely	12a. plan to delay having sexual intercourse until you graduate high school or receive your GED. Much less likely
12b. plan to delay having sexual intercourse until you graduate college or complete another education or training program.	12b. plan to delay having sexual intercourse until you graduate college or complete another education or training program. Much more likely	12b. plan to delay having sexual intercourse until you graduate college or complete another education or training program. Somewhat more likely	12b. plan to delay having sexual intercourse until you graduate college or complete another education or training program. About the same	12b. plan to delay having sexual intercourse until you graduate college or complete another education or training program. Somewhat less likely	12b. plan to delay having sexual intercourse until you graduate college or complete another education or training program. Much less likely
12c. plan to delay having sexual intercourse until you are married.	12c. plan to delay having sexual intercourse until you are married. Much more likely	12c. plan to delay having sexual intercourse until you are married. Somewhat more likely	12c. plan to delay having sexual intercourse until you are married. About the same	12c. plan to delay having sexual intercourse until you are married. Somewhat less likely	12c. plan to delay having sexual intercourse until you are married. Much less likely
12d. plan to be married before you have a child.	12d. plan to be married before you have a child. Much more likely	12d. plan to be married before you have a child. Somewhat more likely	12d. plan to be married before you have a child. About the same	12d. plan to be married before you have a child. Somewhat less likely	12d. plan to be married before you have a child. Much less likely
12e. plan to have a steady full-time job before you get married.	12e. plan to have a steady full-time job before you get married. Much more likely	12e. plan to have a steady full-time job before you get married. Somewhat more likely	12e. plan to have a steady full-time job before you get married. About the same	12e. plan to have a steady full-time job before you get married. Somewhat less likely	12e. plan to have a steady full-time job before you get married. Much less likely
12f. plan to have a steady full-time job before you have a child.	12f. plan to have a steady full-time job before you have a child. Much more likely	12f. plan to have a steady full-time job before you have a child. Somewhat more likely	12f. plan to have a steady full-time job before you have a child. About the same	12f. plan to have a steady full-time job before you have a child. Somewhat less likely	12f. plan to have a steady full-time job before you have a child. Much less likely

The next questions ask about some personal behaviors, including sex and pregnancy. Remember, all of your responses will be kept private.

Question Title

* 13. As a result of being in the program, are you planning to abstain from sexual intercourse (choose to not have sexual intercourse)?

Yes- GO TO QUESTION 14 (after selecting your answer)

No- GO TO QUESTION 15 (after selecting your answer)

Not sure- GO TO QUESTION 15 (after selecting your answer)

Question Title

* Note: Do not answer this question if you responded "No" or "Not sure" to question 13.
14. How important are each of these reasons in your decision to not have sexual intercourse?
Mark only one answer per row.

	Not at all important	Not too important	Somewhat important	Very important
14a. how it might affect your plans for the future.	14a. how it might affect your plans for the future. Not at all important	14a. how it might affect your plans for the future. Not too important	14a. how it might affect your plans for the future. Somewhat important	14a. how it might affect your plans for the future. Very important
14b. the possible emotional consequences (for example, feeling sadness or regret).	14b. the possible emotional consequences (for example, feeling sadness or regret). Not at all important	14b. the possible emotional consequences (for example, feeling sadness or regret). Not too important	14b. the possible emotional consequences (for example, feeling sadness or regret). Somewhat important	14b. the possible emotional consequences (for example, feeling sadness or regret). Very important
14c. the possible social consequences (for example, get a bad reputation or have rumors spread about you, have to deal with drama, make your relationship with someone you are dating or going out with worse, or get in trouble with your parents).	14c. the possible social consequences (for example, get a bad reputation or have rumors spread about you, have to deal with drama, make your relationship with someone you are dating or going out with worse, or get in trouble with your parents). Not at all important	14c. the possible social consequences (for example, get a bad reputation or have rumors spread about you, have to deal with drama, make your relationship with someone you are dating or going out with worse, or get in trouble with your parents). Not too important	14c. the possible social consequences (for example, get a bad reputation or have rumors spread about you, have to deal with drama, make your relationship with someone you are dating or going out with worse, or get in trouble with your parents). Somewhat important	14c. the possible social consequences (for example, get a bad reputation or have rumors spread about you, have to deal with drama, make your relationship with someone you are dating or going out with worse, or get in trouble with your parents). Very important
14d. the risk of getting a sexually transmitted infection (STI).	14d. the risk of getting a sexually transmitted infection (STI). Not at all important	14d. the risk of getting a sexually transmitted infection (STI). Not too important	14d. the risk of getting a sexually transmitted infection (STI). Somewhat important	14d. the risk of getting a sexually transmitted infection (STI). Very important
14e. the risk of getting pregnant or getting someone pregnant.	14e. the risk of getting pregnant or getting someone pregnant. Not at all important	14e. the risk of getting pregnant or getting someone pregnant. Not too important	14e. the risk of getting pregnant or getting someone pregnant. Somewhat important	14e. the risk of getting pregnant or getting someone pregnant. Very important

The next questions ask about your experiences in the program that you just completed. Think about all of the sessions or classes of the program that you attended.

Question Title

* 15. Even if you didn't attend all of the sessions or classes in this program, how often in this program ...
Mark only one answer per row.

	All of the Time	Most of the Time	Some of the Time	None of the Time
15a. did you feel interested in program sessions and classes?	15a. did you feel interested in program sessions and classes? All of the Time	15a. did you feel interested in program sessions and classes? Most of the Time	15a. did you feel interested in program sessions and classes? Some of the Time	15a. did you feel interested in program sessions and classes? None of the Time
15b. did you feel the material presented was clear?	15b. did you feel the material presented was clear? All of the Time	15b. did you feel the material presented was clear? Most of the Time	15b. did you feel the material presented was clear? Some of the Time	15b. did you feel the material presented was clear? None of the Time
15c. did discussions or activities help you to learn program lessons?	15c. did discussions or activities help you to learn program lessons? All of the Time	15c. did discussions or activities help you to learn program lessons? Most of the Time	15c. did discussions or activities help you to learn program lessons? Some of the Time	15c. did discussions or activities help you to learn program lessons? None of the Time
15d. did you have a chance to ask questions about topics or issues that came up in the program?	15d. did you have a chance to ask questions about topics or issues that came up in the program? All of the Time	15d. did you have a chance to ask questions about topics or issues that came up in the program? Most of the Time	15d. did you have a chance to ask questions about topics or issues that came up in the program? Some of the Time	15d. did you have a chance to ask questions about topics or issues that came up in the program? None of the Time
15e. did you feel respected as a person?	15e. did you feel respected as a person? All of the Time	15e. did you feel respected as a person? Most of the Time	15e. did you feel respected as a person? Some of the Time	15e. did you feel respected as a person? None of the Time
15f. were you picked on, teased, or bullied in this program?	15f. were you picked on, teased, or bullied in this program? All of the Time	15f. were you picked on, teased, or bullied in this program? Most of the Time	15f. were you picked on, teased, or bullied in this program? Some of the Time	15f. were you picked on, teased, or bullied in this program? None of the Time

Question Title

* 16. Now thinking about all youth in this program, how often ...
Mark only one answer per row.

	All of the Time	Most of the Time	Some of the Time	None of the Time
16a. were any youth in this program picked on, teased, or bullied?	16a. were any youth in this program picked on, teased, or bullied? All of the Time	16a. were any youth in this program picked on, teased, or bullied? Most of the Time	16a. were any youth in this program picked on, teased, or bullied? Some of the Time	16a. were any youth in this program picked on, teased, or bullied? None of the Time

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* I understand and agree that completing this survey is voluntary.

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* 1. How old are you?Mark only one answer.

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* 2. What grade are you in? (If you are currently on vacation or in summer school, indicate the grade you will be in when you go back to school.)Mark only one answer.

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* 3. When you are at home or with your family, what language or languages do you usually speak?Mark all that apply.

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* 4. Are you Hispanic or Latino?Mark only one answer.

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* 5. What is your race?Mark all that apply.

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* 6. What is your sex?Mark only one answer.

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* 7. Are you currently ...?Mark all that apply.

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* 8. Has being in the program made you more likely, about the same, or less likely to...(Note: If the program has not affected your likelihood to do any of the following, choose "About the same.")Mark only one answer per row.

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* 9. Has being in the program made you more likely, about the same, or less likely to...(Note: If the program has not affected your likelihood to do the following, choose "About the same.")Mark only one answer per row.

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* 10. Has being in the program made you more likely, about the same, or less likely to...(Note: If the program has not affected your likelihood to do the following, choose "About the same.")Mark only one answer per row.

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* 11. Has being in the program made you more likely, about the same, or less likely to...(Note: If the program has not affected your likelihood to do the following, choose "About the same.")Mark only one answer per row.

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* 12. Has being in the program made you more likely, about the same, or less likely to...Mark only one answer per row.

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* 13. As a result of being in the program, are you planning to abstain from sexual intercourse (choose to not have sexual intercourse)?

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* Note: Do not answer this question if you responded "No" or "Not sure" to question 13.14. How important are each of these reasons in your decision to not have sexual intercourse?Mark only one answer per row.

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* 15. Even if you didn't attend all of the sessions or classes in this program, how often in this program ...Mark only one answer per row.

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* 16. Now thinking about all youth in this program, how often ...Mark only one answer per row.

* 1. How old are you?
Mark only one answer.

* 2. What grade are you in? (If you are currently on vacation or in summer school, indicate the grade you will be in when you go back to school.)
Mark only one answer.

* 3. When you are at home or with your family, what language or languages do you usually speak?
Mark all that apply.

* 4. Are you Hispanic or Latino?
Mark only one answer.

* 5. What is your race?
Mark all that apply.

* 6. What is your sex?
Mark only one answer.

* 7. Are you currently ...?
Mark all that apply.

* 8. Has being in the program made you more likely, about the same, or less likely to...
(Note: If the program has not affected your likelihood to do any of the following, choose "About the same.")
Mark only one answer per row.

* 9. Has being in the program made you more likely, about the same, or less likely to...
(Note: If the program has not affected your likelihood to do the following, choose "About the same.")
Mark only one answer per row.

* 10. Has being in the program made you more likely, about the same, or less likely to...
(Note: If the program has not affected your likelihood to do the following, choose "About the same.")
Mark only one answer per row.

* 11. Has being in the program made you more likely, about the same, or less likely to...
(Note: If the program has not affected your likelihood to do the following, choose "About the same.")
Mark only one answer per row.

* 12. Has being in the program made you more likely, about the same, or less likely to...
Mark only one answer per row.

* Note: Do not answer this question if you responded "No" or "Not sure" to question 13.
14. How important are each of these reasons in your decision to not have sexual intercourse?
Mark only one answer per row.

* 15. Even if you didn't attend all of the sessions or classes in this program, how often in this program ...
Mark only one answer per row.

* 16. Now thinking about all youth in this program, how often ...
Mark only one answer per row.