Lifestyle Questionnaire

INSTRUCTIONS: Please print out the questionnaire and answer the questions as best you can in the space provided. You can write clarifying notes in the margin if needed. NOTE: Responses to all questions will be kept anonymous. I need your name to make sure you have done the assignment, and to correlate the data with other questionnaires. However, if there is a question you find alarming or offensive, just don't answer it. Thanks for your participation!

Your Name: ___________________________________ (important!)

1. What is your major? ____________________
2. What year are you? Freshman | Sophomore | Junior | Senior
3. What is your GPA? ____________________
4. Do you work while going to school? Don't work | Part-time | Full-time
5. How many hours do you study per 7-day week in a typical semester? ____________________
6. How many units of alcohol do you drink in a typical 7-day week while at school? One unit of alcohol is equal to one bottle of beer, or one glass of wine or one mixed drink. ____________________
7. How many nights a week (including weekend) do you go out with friends? ____________________
8. How tall are you? ____________________
9. How much do you weigh? ____________________
10. What color is your hair right now? ____________________
11. Do you color your hair? ____________________
12. What were your VERBAL SAT scores? ____________________
13. What were your MATH SAT scores? ____________________
14. What country do you come from? ____________________
15. What language are you most comfortable speaking? ____________________

Thank you!