Teen "Life" Survey
Take The Survey
Take this survey about your life as a teenager. Tell your friends!! Eventually, once we receive enough information, we will produce results in the form of charts showing the general trends between teenagers like you. Taking the survey is easy, just answer the questions ranging from favorite music to your age, and other topics. After you are finished with the questions, click on the "Send" button to complete the survey. Note that to add multiple responses on categories such as sports, just separate them with a comma.


The Survey
General Information
First Name
Last Name Initial
GenderMale Female
Age
County (Only Major Listed)
State (USA Only)

Music
Favorite Band
Least Favorite Band
Favorite Song
Least Favorite Song
Have you ever created a band?Yes No
Do/Did you play an instrument?Yes No
If yes, what instrument(s)?
If no, do you plan to play an instrument?Yes No

Media
Favorite Movie
Least Favorite Movie
Favorite TV Station (Give Name Like Fox or CNN)
Least Favorite TV Station
Favorite Radio ThemeTalk/News Music
Do you read newspapers?Yes No
Do you read magazines?Yes No

Athletics
Do/Did you play a sport?Yes No
If yes, what sport(s)?
What is your favorite sport? (Pro)
Do you have a favorite team? (Pro)Yes No
If yes, what is your favorite team(s)?
Have you ever taken a performance drug?Yes No

Sexuality
Have you ever had sexual intercourse?
If yes, have you ever had unprotected sex?Yes No
If yes to #1, with your current boyfriend/girlfriend?Yes No N/A
Have you ever performed/received oral sex?Yes No
Have/Do you masturbate?
Have you ever watched porn?Yes No
What is your current relationship status?

Internet
Do you visit places on the internet w/o permission from parents?Yes No
Do you use AIM?Yes No
Do you use YIM (Yahoo)?Yes No
Do you use ICQ?Yes No
Do you use MSN Messenger?Yes No
Do you use another instant messenger?Yes No
If yes, what other program(s)?
Do you have a My Space?Yes No
Do you have your own website?Yes No

Substances
Do you drink alcohol?Yes No
Have you ever been drunk?Yes No
Have you ever taken drugs (not medicine from doctor)?Yes No
Have you ever sold drugs?Yes No

Religious Beliefs
Do you believe in a higher power?Yes No
Do you belong to a religion?Yes No
If yes, what religion?
Do you let religion influence daily life?

Conclusion
Date (MM/DD/YYYY)//

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