Site Network: Main | Students | Parents | Universities | Chapters

 

 

 

 

 

Back Home »

Take the SEMS Foundation's student survey

Please indicate the approximate number of days per month you participate in the activity in question. Thanks for taking the time to fill out our student survey.

How often?

1) Not able to do your homework or study for a test?

2) Got into fights, acted badly, or did mean things?

3) Missed out on other things because you spent too much money on alcohol?     

4) Went to work or school high or drunk?

5) Caused shame or embarrassment to someone?

6) Neglected your responsibilities?

7) Had a relative avoid you?

8) Felt that you needed more alcohol than you used to use in order to get the same effect?

9) Tried to control your drinking by trying to drink only at certain times of the day or in certain places?

10) Had withdrawal symptoms, that is, felt sick because you stopped or cut down on drinking?

11) Noticed a change in your personality?

12) Felt that you had a problem with alcohol?

13) Missed a day (or part of a day) of school or work?
 
14) Tried to cut down or quit drinking?
 
15) Suddenly found yourself in a place that you could not remember getting to?

16) Passed out or fainted suddenly?
 
17) Had a fight, argument or bad feelings with a friend?

18) Had a fight, argument or bad feelings with a family member?

19) Kept drinking when you promised yourself not to?
   
20) Felt you were going crazy?

21) Had a bad time?
  
22) Felt physically or psychologically dependent?

23) Was told by a friend or neighbor to stop or cut down drinking?

24) Had sex with someone you would not have, had you been sober, or did not use protection when you had sex?

25) Drove shortly after having more than four drinks?

26) Experienced nausea or vomiting?

27) Had a hangover?
  



Your phone (000-000-0000 if you prefer to remain anonymous)

Your email