The province of your school: _____________________
1. How many people usually live in your household*? Don’t forget to count yourself in! _____
*Note: Your household means your home. If you live in more than one home, choose the one in which
you spend the most time. The term “household” is used in the Census of Canada.
2. What language do you most often speak at home? Choose one:
• English • French • Spanish • Chinese • Punjabi • Arabic • German • Italian • Spanish • Arabic
• Portuguese • German • Polish • Urdu • Vietnamese • Tagalog (Filipino) • Hindi • Persian (Farsi)
• Cree • Tamil • Russian • Korean • Greek • Other
3. Are you male or female? _____
4. What is your age in years? _____ years
5. What is your height, without shoes, in centimetres? ______ cm
6. What is your arm span in centimetres? (Open arms wide, measure distance from tip of right hand
middle finger to tip of left hand middle finger.) ______ cm
7. What is the length of your right forearm, from your elbow bone to your wrist bone, in
centimetres? ______cm
8. What is your wrist circumference in millimetres? _____mm
9. What is the length of your right hand from your wrist bone to the tip of the middle finger, in
centimetres?_____cm
10. What is the length of your right foot, without a shoe, in centimetres? _____cm
11. What colour are your eyes?
• Blue • Brown • Green • Other
12. In most activities, which are you?
• Left-handed • Right-handed • Ambidextrous
(Note: The following two questions can only be answered using the online questionnaire.)
13. How fast is your reaction time with your right hand?
Place the mouse in your right hand, click ‘Start’. When the words “Press Stop” appear in the box, click
‘Stop’ as fast as you can.
14. How fast is your reaction time with your left hand?
Place the mouse in your left hand, click ‘Start’. When the words “Press Stop” appear in the box, click
‘Stop’ as fast as you can.
15. What do you usually have for breakfast? Choose all the groups that apply:
• Grain products: (e.g., bread, cereal, toast, muffin, bagel, rice, pasta)
• Milk products: (e.g., milk, cheese, yogurt)
• Vegetables and fruits: (e.g., juice, bananas, oranges, carrots, tomatoes)
• Meat and alternatives: (e.g., eggs, bacon, chicken, peanut butter, beans)
• Other: (e.g., tea, coffee, pop, chips, cookies, donuts)
• No breakfast
16. How many cigarettes a week do you usually smoke?(Write in number) ______
17. In the last week, approximately how much time did you spend, to the nearest hour, on each
of the following activities? Make sure that the total does not add up to more than 168 hours.
Playing computer or video games____ hours
Reading (not schoolwork) _____hours
Watching TV, videos or movies _____hours
Playing or listening to music _____hours
Playing board or card games _____hours
Doing homework _____hours
Doing jobs at home _____hours
Working for pay outside the home____ hours
Doing community volunteer work ____ hours
Participating in sports _____ hours
Hanging out with friends _____ hours
18. How much pressure do you feel because of the schoolwork you have to do? Choose one:
• none • very little • some • a lot
19. In the last year have you gone on a diet, changed your eating habits or done anything to
control your weight?
• Yes • No
20. On how many days last week did you do a physical activity that made you huff and puff or
made you feel out of breath, tired or warmer than usual? Choose one:
• 0 • 1 • 2 • 3 • 4 • 5 • 6 • 7
21. How do you usually travel to school? Choose one:
• walk • skateboard • inline skate • bicycle • motorcycle • moped • bus
• car • train • subway or metro • other
22. How long does it usually take you to travel to school? _____ minutes
23. What is your favourite subject at school? Choose one:
• art • English • French • social studies • history • geography • math
• science • computers • music • physical education • other
24. In the last month, how many times have you been bullied* at school? Choose one:
• 0 • 1 to 3 • 4 to 9 • 10 or more
* Note: Being bullied means when someone does or says something to make you feel uncomfortable or afraid
25. Do you have any of the following? Choose all that apply:
• your own calculator • your own cell phone • your own pager • access to a computer at home • access
to the Internet at home • your own MP3 or mini disc player
26. Which of these methods do you most often use to talk to your friends? Choose one:
• Telephone (landline)
• Cell phone
• Text messaging
• E-mail
• Internet chat or MSN
• In person
• Other
27. If you had $1,000 to donate to a charity of your choice, what type of organization would you
choose? Choose one:
• Arts, culture, sports (e.g., community centres, museums, sports teams, music programs)
• Health (e.g., cancer, AIDS, diabetes research)
• Religious (e.g., church or activities related to worship)
• Environment (e.g., saving forests, clean air, clean water)
• Wildlife, animals (e.g., endangered species, prevention of cruelty to animals)
• Education / Youth development (e.g., reading, literacy and skills training, after-school programs)
• International aid (e.g., disaster relief, health, education and food aid in poor countries)
• Other
28. What do you think is the most important issue facing young Canadians today? Choose one:
• unemployment • environment • economy • health • migration / immigration • other
29. Think about someone you most look up to. This could be someone you know personally or
have read about or seen on T.V. From the list below, choose the category that best describes
this person.
• Relative
• Actor
• Sportsperson
• Coach or club leader
• Business person
• Religious figure
• Politician
• Teacher
• Doctor or nurse
• Musician or singer
• Friend
• Community leader or elder
• Other
