STAT 250 Survey Data Collection Form


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)?
 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.  natural brothers
17.  adopted brothers
18.  half brothers
19.  step brothers

How many sisters do you have?
20.  natural sisters
21.  adopted sisters
22.  half sisters
23.  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?
 times

30. How many credits are you taking this semester?
 credits

31. How many hours a day do you typically spend studying?
 hours

32. How many classes do you usually skip in a week?
 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?
 hours

36. How many books did you read for pleasure in the past 30 days?
 books

37. 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

38. Do you abstain from drinking alcohol?
Yes (Skip to question 40.)
No
No response

39. Which type of alcohol do you drink most often?
Beer
Wine
Hard liquor
Other
No response

40. Have you ever smoked marijuana?
Yes
No
No response


Personal Belongings

41. Do you maintain a car in State College?
Yes
No
No response

42. Do you maintain a bike in State College?
Yes
No
No response

43. How many pairs of jeans do you own?
 jeans

44. How many music compact discs (CDs) do you own?
 CDs

45. Do you own a computer?
Yes
No
No response

46. Do you own a cellular telephone?
Yes
No
No response

47. Do you own a pet?
Yes
No
No response


Residence & Personal Life

48. Do you live on campus?
Yes
No
No response

49. What is your primary mode of transportation in State College?
Walking
Driving a car
Riding a bike
Riding the bus
No response

50. Are you member of a fraternity or a sorority?
Yes
No
No response

51. How many people do you currently live with while at Penn State?
 people

52. Do you currently have a "steady" boyfriend or girlfriend?
Yes
No (Skip to question 54.)
No response

53. Does he or she attend Penn State?
Yes
No
No response

54. Are you holding a job for pay this semester?
Yes
No (Stop here.)
No response

55. Approximately how many hours per week will you work?
 hours