CJD #girlstrong Pre-Survey

Ages 11-18

Boys & Girls Clubs of ______

Site: ______

Student Name: ______DOB: ______

Instructions

Thank you for taking this survey today! Your opinion is important to us, and we appreciate your time.

This survey is designed to find out about you, your opinions and your experiences. Please answer honestly as there are no right or wrong answers.

How much do you agree or disagree with each of the following statements: (Please choose one answer for each statement.)

Self-esteem is… /
a. / Your reflection in a mirror /
b. / How you feel about yourself /
c. / How others feel about you /
d. / How you feel about others /
Menstruation, or having a period, can cause… /
a. / bleeding /
b. / A bad mood /
c. / Abdominal cramps /
d. / All of the above /
Exercise or physical activity…
a. / Helps you vent your feelings /
b. / Lowers stress /
c. / Produces endorphins, which make you feel good
d. / All of the above /
Which of these is the only 100% effective way to prevent pregnancy? /
a. / Abstinence, or not having sex
b. / Using a condom
c. / Taking birth control pills
d. / Having sex standing up
Healthy friendships are built on… /
a. / Respect and trust /
b. / Being in the same class /
c. / Forcing someone to hang out with you
d. / Talking behind someone’s back.
Being as thin as the models in magazines is the key to happiness. /
True False
Sexual feelings are normal and can be controlled.
True False
Puberty is the transition time between being a kid and being an adult.
True False
Nutritious Foods are breaded or fried.
True False
A SMART Girl is respectful and honest.
True False
Peer pressure is always negative.
True False
Texting and driving is totally safe.
True False
The message I send from my computer or phone can ONLY be read by the person I am sending it to.
True False
Chatting with a stranger online can be dangerous.
True False
What I say or post online can affect my future.
True False
It is safe to “friend” as many people as possible even if you don’t know them.
True False
If you give out personal information online, it can be used to harm and/or exploit you.
True False
It is OK to meet a cyber “friend” offline.
True False

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