1. How old are you?

2. What year in school are you at UMM?

3. Gender

4. Race

5. Where do you live?

6. Are you currently employed?

7. Are you involved in any extracurricular activities (such as sports, music, clubs, volunteer work, etc)?

8. What is your GPA?

9. Have you ever used any mind altering drugs such as marijuana, cocaine, alcohol, etc?

10. Do you currently use any mind altering drugs such as marijuana, cocaine, alcohol, etc?

11. If you ever experimented with any drugs or alcohol, at what age did you first experiment?

12. Have you ever used methamphetamine?

13. Do you currently use methamphetamine?

14. If you ever used methamphetamine, at what age did you first try it?

15. If you currently use methamphetamine, how frequently do you use it?

16. If you ever used methamphetamine, why did you try it (check all that apply)?

Encouragement of family or friends
To lose weight
To improve my quality of work at school/at my job
Other
I don't use methamphetamines

17. Have you ever gone through a chemical depedency treatment program?

18. If you answered question #17 "yes", please write which chemical dependencies you were being treated for.

19. Do you know anyone who manufactures methamphetamine?

20. Has anyone close to you (family, close friends) used methamphetamine?

21. Have you ever known of an acquaintance, or someone you are not close to, who used methamphetamines?

22. Has anyone close to you gone through, or is currently in, a chemical dependency treatment program?

23. Have you ever dealt with the break-up of a family (through divorce or loss of custody) because of drug use?

24. Have you ever dealt with the break-up of a family specifically because of methamphetamine use?

25. Have you personally suffered any physical injuries as a result of someone else's drug use?

26. Have you personally suffered any physical injuries as a result of someone else's methamphetamine use?

27. Has anyone in your family died due to drug use?

28. Have you ever been in a vehicular accident with someone under the influence of drugs or alcohol?