STAT 250 Survey Data Collection Form A
General Background
1. What is your gender?
Male
Female
No response
2. What is your age in years (as of today)?
years
3. What is your race?
Aleut, Eskimo, or American Indian
Asian or Pacific Islander
African-American/Black
Caucasian/White
Other
No response
4. Is your mother or father of Latino or Hispanic origin?
Yes
No
No response
5. What is your height (with your shoes off, to the nearest inch)?
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
inches
6. What is your weight (undressed, to the nearest pound)?
pounds
7. What do you think is your ideal weight?
pounds
Appearance
8. Which of the following best describes your natural hair color?
Dark Brown
Light Brown
Blonde
Black
Red
Other
No response
9. Have you ever dyed your hair?
Yes
No
No response
10. Which of the following best describes your eye color?
Blue
Green
Hazel
Brown
Black
Red
Other
No response
11. Do you wear corrective eye lenses?
Yes
No
No response
12. Do you have a tattoo?
Yes
No
No response
13. Have you ever pierced your ears?
Yes
No
No response
14. Have you ever pierced any other part of your body?
Yes
No
No response
Family Background
15. Are your parents divorced or separated?
Yes
No
No response
How many brothers do you have?
16.
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
natural brothers
17.
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
adopted brothers
18.
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
half brothers
19.
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
step brothers
How many sisters do you have?
20.
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
natural sisters
21.
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
adopted sisters
22.
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
half sisters
23.
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
step sisters
24. Which of the following best describes your birth order in your family?
Only child
Youngest child
A middle child
Oldest child
No response
Education
25. What is your semester standing?
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Eighth
Other
No response
26. What is your cumulative grade point average (through last semester)?
27. Have you ever failed a college course?
Yes
No
No response
28. Have you ever cheated on an exam in college?
Yes
No
No response
29. How many times have you changed your college major?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
times
30. How many credits are you taking this semester?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
credits
31. How many hours a day do you typically spend studying?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
hours
32. How many classes do you usually skip in a week?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
classes
33. Do you think PSU is meeting your educational needs?
Yes
No
No response
34. Do you currently plan to attend graduate school or a professional school?
Yes
No
No response
Leisure Activities
35. To the nearest hour, how many hours of TV did you watch last night?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
hours
36. How many minutes do you typically talk on the telephone each week?
minutes
37. How many minutes do you typically spend exercising each week?
minutes
38. How many books did you read for pleasure in the past 30 days?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
books
39. If you had one hour of free time tonight, which one of the following activities would you most likely do?
Read a book
Watch TV
Exercise
Listen to music
Party
Hang out with friend(s)
Play video or computer games
Surf the internet
Other
No response
40. Do you abstain from drinking alcohol?
Yes
(Skip to question 42.)
No
No response
41. Which type of alcohol do you drink most often?
Beer
Wine
Hard liquor
Other
No response
42. Have you ever smoked marijuana?
Yes
No
No response
Personal Belongings
43. Do you maintain a car in State College?
Yes
No
No response
44. Do you or your parents own a sport utility vehicle?
Yes
No
No response
45. Do you maintain a bike in State College?
Yes
No
No response
46. How many pairs of jeans do you own?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
jeans
47. How many music compact discs (CDs) do you own?
CDs
48. How much money did you spend on textbooks this semester?
Do NOT enter the dollar sign. Only enter the number.
dollars
49. Do you own a computer?
Yes
No
No response
50. Do you own a cellular telephone?
Yes
No
No response
51. Do you own a pet?
Yes
No
No response
Residence, Behavior & Personal Life
52. Where is your primary residence?
In Pennsylvania
Out of Pennsylvania
No response
53. While at school, do you live on campus?
Yes
No
No response
54. Are you member of a fraternity or a sorority?
Yes
No
No response
55. How many people do you currently live with while at Penn State?
people
56. What is your primary mode of transportation in State College?
Walking
Driving a car
Riding a bike
Riding the bus
No response
57. Do you support yourself through school?
Yes
No
No response
58. Do you consider yourself sleep-deprived?
Yes
No
No response
59. Do you recycle regularly?
Yes
No
No response
60. How many times a month do you do laundry?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
times
61. How many moving violations (such as speeding tickets) have you received?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
tickets
62. How many times a day do you comb your hair?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
times
63. Do you currently have a "steady" boyfriend or girlfriend?
Yes
No
(Skip to question 65.)
No response
64. Does he or she attend Penn State?
Yes
No
No response
65. Are you holding a job for pay this semester?
Yes
No
No response
