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Gender:
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Choose
male
female
How old are you? Write a number ex: 16
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Your answer
School Grade:
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Junior 1:
Junior 2:
Junior 3:
Senior 1:
Senior 2:
Senior 3:
How many people live in your home with you?
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Small family (3 or fewer.)
Average family (4-5)
Large family (6+)
Please answer honestly!
Q#1: Have you ever changed a baby's diaper?
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Yes, I have.
No, I haven't.
No, but I have helped wash/shower a younger brother/sister/family member.
Q#2: Have you ever cooked breakfast for yourself? (39)
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Yes, I have.
No, I haven't.
Yes, I was cooking this morning !
Q#3: Have you ever been abroad? (9, 36)
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Yes, I have.
No, I haven't.
Yes, I have been abroad several times !
Q#4: Have you ever gone on a trip alone?(8,46)
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Yes, I have.
No, I haven't.
Q#5: Have you ever been to concert?
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Yes, I have.
No, I haven't.
No, but I want to go to concert !
Q#6: Have you ever ridden a bike?(12,41)
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Yes, I have.
No, I haven't.
Q#7: Have you ever smoked ?(12,41)
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Yes, I have.
No, I haven't.
No, but I want to try.
Q#8: Have you ever tried durian ?(42,3)
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Yes, I have.
No, I haven't.
No, but I want to try.
Q#9: Have you ever been to Japan before?(02,21)
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Yes, I have.
No, I haven't.
No, but I been to Korea before.
Q#10: Have you ever ridden a horse?(05,23)
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Yes, I have.
No, I haven't.
No, but i want to try.
Q#11: Have you ever pierced your ear?(24,34)
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Yes, I have.
No, I haven't.
Yes, I have many.
Q#12: Have you ever worn contact lenses?
(28, 29)
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Yes, I have.
No, I haven't.
Yes, I am wearing contact lenses now.
Q#13: Have you ever had a pet dog or cat?(14)
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Yes, I have.
No, I haven't.
Yes, I have many.
Part 2
Q#14: Have you ever kissed a boy or a girl?(19.11)
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Yes, I have.
No, I haven't.
Yes, I have many times!
Q#15: Have you ever gone to church?(22.)
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Yes, I have.
No, I haven't.
Yes, I go every week.
Q#16: Have you ever seen a ghost?(45)
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Yes, I have.
No, I haven't.
Q#17: Have you ever eaten a pizza by yourself?
(35.27)
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Yes, I have.
No, I haven't.
Q#18: Have you ever used an e-cigarette? (17.40)
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Yes, I have.
No, I haven't.
Yes, I do everyday.
Q#19: Have you ever been punched in the face? (25.13)
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Yes, I have.
No, I haven't.
Q#20: Have you ever been inside Taipei 101? (10.20)
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Yes, I have.
No, I haven't.
Q#21: ? Have you ever eaten shrimp? (30.31)
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Yes, I have.
No, I haven't.
Q#22: Have you ever eaten a bug ? (6.15)
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Yes, I have.
No, I haven't.
Q#23: Have you ever dropped your phone in the toilet ? (44)
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Yes, I have.
No, I haven't.
Q#24: Have you ever bought something online? (6.15)
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Yes, I have.
No, I haven't.
Yes, almost every week.
Q#25: Have you ever dyed your hair? (XX)
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Yes, I have.
No, I haven't.
End of STUDENT QUESTIONS.
END 1: I understand that no one will see my name or answers about this information.
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I understand.
I don't understand.
END 2: All of the information I wrote here is true as much as possible.
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Yes!
No!
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