Midcoast High School Survey Question Title * 1. What is your gender? Male Female Transgender - Female Transgender - Male Gender Neutral OK Question Title * 2. What grade level did you begin in September of 2017? 9 10 11 12 OK Question Title * 3. Are there questions about drugs and/or alcohol you would like to ask your parents or teachers but have been too afraid or embarrassed to ask? Yes No OK Question Title * 4. Do you have a friend or do you know someone about your age that you are worried may have a problem with drugs or alcohol? Yes No OK Question Title * 5. If you had a friend with a drug or alcohol problem who would you ask for help? Choose an answer for each option. Yes No Maybe Your parents Your parents Yes Your parents No Your parents Maybe My friend's parents My friend's parents Yes My friend's parents No My friend's parents Maybe School Guidance Counselor School Guidance Counselor Yes School Guidance Counselor No School Guidance Counselor Maybe School Nurse School Nurse Yes School Nurse No School Nurse Maybe School Resource Officer School Resource Officer Yes School Resource Officer No School Resource Officer Maybe Principal Principal Yes Principal No Principal Maybe Teacher Teacher Yes Teacher No Teacher Maybe Coach Coach Yes Coach No Coach Maybe Religious leader Religious leader Yes Religious leader No Religious leader Maybe Doctor Doctor Yes Doctor No Doctor Maybe Try to get them to ER Try to get them to ER Yes Try to get them to ER No Try to get them to ER Maybe Google for information to help Google for information to help Yes Google for information to help No Google for information to help Maybe Other Adult - please add (ex - aunt, neighbor, cousin) OK Question Title * 6. Say you told your friend you were worried about them and that you had a way to get help for their drug or alcohol problem, but they said no.Why do you think they would refuse help? Because they...(Check the ones you think could be true) Liked the drugs or alcohol too much Worried they could not pay to get help Worried they did not have transportation to get to appointments for treatment Worried they would miss school and get into trouble or suspended Could not afford to miss work to come to treatment appointments Worried that they would be teased or bullied if others found out they were getting treatment Worried they would get in trouble at home if they said they needed help Worried that treatment might be worse than drugs or alcohol Need the drugs or alcohol to feel normal so cannot stop Worried they would get in trouble with the law Worried they would be kicked off a team or club Other (please specify) OK Question Title * 7. Do you have a friend or know someone who might be seriously depressed , anxious or at risk for suicide? Yes No OK Question Title * 8. Would you know how to get help for a friend who was suffering from depression, anxiety or was having suicidal thoughts? Yes No OK Question Title * 9. Would you ask for help for a friend suffering from depression or anxiety from any of these people? Choose an answer for each option. Yes No Maybe Your parents Your parents Yes Your parents No Your parents Maybe My friend's parents My friend's parents Yes My friend's parents No My friend's parents Maybe School Guidance Counselor School Guidance Counselor Yes School Guidance Counselor No School Guidance Counselor Maybe School Nurse School Nurse Yes School Nurse No School Nurse Maybe School Resource Officer School Resource Officer Yes School Resource Officer No School Resource Officer Maybe Principal Principal Yes Principal No Principal Maybe Teacher Teacher Yes Teacher No Teacher Maybe Coach Coach Yes Coach No Coach Maybe Religious leader Religious leader Yes Religious leader No Religious leader Maybe Doctor Doctor Yes Doctor No Doctor Maybe Try to get them to ER Try to get them to ER Yes Try to get them to ER No Try to get them to ER Maybe Google for information to help Google for information to help Yes Google for information to help No Google for information to help Maybe Other Adult - please add (ex - aunt, neighbor, cousin) OK Question Title * 10. If a friend who was suffering from depression or anxiety told you they do not want any help. Why do you think they would say this?(Check all you believe may be true.) They did not think it was a problem Worried they would get in trouble with the law Worried they would get in trouble at home Worried they could not pay for help Worried they did not have transportation to get to appointments worried they would miss school and get into trouble or suspended from school Could not afford to miss work to come to treatment appointments Worried that they would be teased or bullied if others found out they were getting treatment Worried they would be kicked off a team or club They were very ill Other (please specify) OK Question Title * 11. Have you thought about what you would like to do when you graduate from High school? Yes, I'd like to attend college Yes, I plan to start working Yes, but I'm not sure yet No, I have not thought about it much OK Question Title * 12. Have you discussed these ideas or plans with anyone at the high school? Yes No OK Question Title * 13. Have you done anything proactive to explore your ideas about after you finish high school, such as research, job search, or looking at colleges? Yes No Not yet, but have plans to OK Question Title * 14. Which type of cell/mobile phone do you have? Smartphone Flip phone Track phone I don't have a phone OK Question Title * 15. Who pays your monthly phone bill? Parents/adult guardian I pay it myself We share the cost OK Question Title * 16. Which types of Social Media and Apps do you use, and how often? Yes, daily Yes, occasionally Rarely Never Facebook Facebook Yes, daily Facebook Yes, occasionally Facebook Rarely Facebook Never Twitter Twitter Yes, daily Twitter Yes, occasionally Twitter Rarely Twitter Never Snapchat Snapchat Yes, daily Snapchat Yes, occasionally Snapchat Rarely Snapchat Never Instagram Instagram Yes, daily Instagram Yes, occasionally Instagram Rarely Instagram Never My Space My Space Yes, daily My Space Yes, occasionally My Space Rarely My Space Never YouTube YouTube Yes, daily YouTube Yes, occasionally YouTube Rarely YouTube Never Live.ly Live.ly Yes, daily Live.ly Yes, occasionally Live.ly Rarely Live.ly Never Houseparty Houseparty Yes, daily Houseparty Yes, occasionally Houseparty Rarely Houseparty Never Others (please list) OK DONE