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* 1. In what grade(s) do you have children? Check all that apply)

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* 2. What school (s) do your children attend?

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* 3. What is your gender?

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* 4. How would you describe yourself?

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* 5. My child is involved in the following activities (check all that apply)

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* 6. I believe youth, in general, have had a drink of alcohol in the past year (not including religious purposes).

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* 7. I believe during the last 30 days, youth (18 and under), in general, have had at least one drink of alcohol (not including religious purposes).

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* 8. On average, in the last 30 days, on how many days do you think youth (18 and under), in general, had 5 or more drinks in a row?

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* 9. In the last 30 days what do you believe youth (18 and under), in general, have drank?

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* 10. Where do you believe that youth (18 and under), in general, get alcohol? (check all that apply)

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* 11. Where do you believe youth (18 and under), in general, use alcohol? (check all that apply)

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* 12. I believe it is okay for youth,(18 and under) in general, to drink beer, wine, or hard liquor under the age of 21 without their parents' permission?

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* 13. I believe it is harmful for those under the age of 21 to drink alcohol.

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* 14. In your neighborhood or community, how difficult do you think it would be for youth (18 and under), in general, to get alcoholic beverages?

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* 15. I believe parents in my community are hosting parties for youths (18 and under) where alcohol is provided.

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* 16. I believe that it is okay for a parent to host a party and provide the alcohol for youth under the age of 21, as long as the teens are not driving.

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* 17. If you believe your child has been to a party where alcohol is present, do you believe your child used alcohol at this party?

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* 18. Alcohol use by those under 21, in general, is OKAY, as long as they remain at home under parental supervision and do not drive under the influence.

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* 19. Would you approve of your underage child using alcohol if they were in your home under your supervision?

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* 20. I set and enforce clear rules regarding alcohol and other drugs with my child.

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* 21. In order to prevent alcohol and drug use among teens in our community, I feel the following groups could do more(check all that apply).

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* 22. Have you heard of young people (18 and under), being caught with alcohol?

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* 23. What have you heard happens when youth (18 and under) get caught with alcohol by the police? (check all that apply)

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* 24. I notice alcohol advertising in my community?

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* 25. I believe that alcohol advertising influences drinking behavior

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* 26. I believe that alcohol in our community is promoted to underage drinkers

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* 27. I believe that local bars or restruants encourage over drinking

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