The province of your school:
1. What is your home postal code?
Write the first three characters.
2. How many people usually live in your household?
Don’t forget to count yourself in!
3. Are you male or female?
4. What is your date of birth? mm
yyyy
Use digits only, month and year
5. What is your age in years?
6. What is your height in centimetres without shoes?
7. What is your hand span in centimetres?
8. What is your wrist circumference in millimetres?
9. What is your foot length in centimetres, right foot without a shoe?
10. What colour are your eyes? blue, brown, green, other
11. What do you usually have for breakfast?
Circle all that apply:
milk, fruit juice, hot beverage, hot cereal, cold cereal, eggs, toast, muffin, bagel, cereal bar, cheese, yogurt, no breakfast, other
12. How many cigarettes a week do you usually smoke?
Circle one:
0, 1 to 3, 4 to 9, 10-20, 21 or more.
13. In the last week, approximately how much time did you spend?
(categories: 0, 1 to 3 hours, 4 to 6 hours, 7 to 9 hours, 10 or more hours)
playing sport
watching live sport
watching sport on T.V.
playing computer sport games
reading about sport
coaching sport
14. In the last week, approximately how much time did you spend?
(categories: 0, 1 to 3 hours, 4 to 6 hours, 7 to 9 hours, 10 or more hours)
being involved with sports
playing video or computer games
playing board or card games
watching T.V. or films
reading
playing or listening to music
doing school homework
doing jobs at home
working for pay outside the home
doing community volunteer work
hanging out with friends
15. How do you usually travel to school?
Circle one:
walk, skateboard, rollerblade, cycle, motorcycle, car, bus, train, subway or metro, other.
16. How long does it usually take you to travel to school? minutes
17. What is your favourite subject at school?
Circle one:
art, English, French, social studies, history, geography, math, science, computers, music, physical education, other.
18. In the last year, how many times have you been bullied at school?
0, 1 to 3, 4 to 9, 10 or more.
19. How many times in the last week did you drop litter (e.g. candy wrappers) elsewhere than in garbage containers?
0, 1 to 3, 4 to 9, 10 or more.
20. Do you have any of the following?
Circle 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
21. 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
22. What are your plans for the year after high school?
Circle one:
university, community college, technical institute, CEGEP, CEGEP followed by university, learn a trade or get vocational training, get a job, travel, other.