Please do not write your name or any identifying information on the survey

Background/demographic questions

Please tell us a little about yourself.

• 1. Are you

• a) male

• b) female

• 2. As of today, how old are you? _

• 3. What grade are you in?

• a) 7th grade

• b) 8th grade

• c) 9th grade

• d) 10th grade

• e) 11th grade

• f) 12th grade

• 4. Do you qualify for the free lunch program at school?

• a) yes

• b) no

• c) unsure/don't know

• 5. Who do you live with?

• a) birth or adoptive Mother and Father

• b) birth or adoptive Mother only

• c) birth or adoptive Father only

• d) family member other than Mother or Father

• e) other non- family member such as foster family or family friend

• 6. What racial/ethnic group or groups do you belong to? (mark all that apply)

• a) Asian

• b) Black

• c) Latino

• d) Native American/American Indian

• e) White

• f) Other

• 7. Using your answer to the last question as a reference, for the racial/ethnic group you identify with, do you believe your skin tone/shade of skin is: (*Note: This question is designed to examine if being darker or lighter than average within your racial/ethnic group is an advantage/disadvantage/neither)

• a) darker than average

• b) about average

• c) lighter than average

• 8. What racial/ethnic group do most people assume you belong to, at least at first impression?

• a) Asian

• b) Black

• c) Hispanic

• d) Native American/American Indian

• e) White

• f) Other

• 9. Did you attend Crooked Oak Schools last school year?

• a) Yes

• b) No

Questions about activity

The following questions are about activities in which you may or may not have participated. For the following questions, please indicate (X) if you participated in any of the following activities.