Me, My Media & Tech Life Profile

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Email *

1. What grade are you in? *

9thGrade

10th Grade

11th Grade

12th Grade

Adult

Other:

2. What are the TOP THREE types of media/ communication technologies you use on a FREQUENT basis (everyday) *

Choose THREE

Phone (voice)

Texting (on phone or device)

Emailing

Social media (Tik Tok, Instagram etc)

Listening to music

Watching TV

Gaming

Youtube

Reading

Podcasts

Surfing the Internet

Other:

Required

3. Click ALL of the following media / social media that you use? *

Facebook

Tik Tok

Instagram

Youtube

Snapchat

Tumblr

Twitter/X

Facetime/Video Chat

Discord

Twitch

Other:

Required

3. TOP THREE you use the MOST (and maybe ADDICTED to)? *

Facebook

Tik Tok

Instagram

Youtube

Snapchat

Tumblr

Twitter

Facetime/Video Chat

Discord

Twitch

Other:

Required

5. HOW MANY HOURS a day do you spend using any/all SOCIAL Media (from list above) *

less than one hour

One hour per day at least

Two to three hours per day

Three to five hours per day

Five to seven hours per day

Over seven hours a day

Never

7. ARE YOU ADDICTED? Which of the following is true for you? (choose ALL that apply) *

I AM addicted to my phone, computer and/or TV and cannot imagine life without it. (even at school)

My parents have complained that I spend too much time on the computer, phone, and/or TV.

I often do not finish my schoolwork because I waste time on the computer, phone and/or TV.

I would prefer being on-line, phone, and/or TV than spending time with others.

My parents have a strict consequences if I use media inappropriately.

My parents threaten me, but never do anything to stop me from enjoying media

NONE of the above

I am NOT addicted to social media, computer and/or TV (I could go without it for a day or more.))

I prefer being involved in my hobbies (music, sports, art, or other)

I love to read and think it is a different experience than other media.

Other:

Required

8. While on social media, what kinds of unwanted communication have you received? (choose ANY THAT APPLY) *

Spam

Advertisers

Parents

Phishing attempt (to hack your acct.)

Bullying

Peer Pressure (but not overt bullying)

Complete strangers who want to be friends with me

Complete strangers who shared adult information (sexual content)

NONE of the above

Other:

Required

9. Choose ANY of the following that apply to your on-line communications? *

I said something mean about someone.

revealed my opinion about someone or something that I should have just kept to myself.

I posted a photograph of myself that was not appropriate (too mature, provocative or sexy).

forwarded an embarrassing photograph or comments that might have hurt someone's feelings.

I accidentally clicked on or downloaded something that I really didn't understand.

I gave away my e-mail or other personal information without thinking much about it.

NONE

Other:

Required

Select the TOP TWO things that cause you the most stress in life. *

Family

Friends

Social Media (it may not be all SM, but could be just one or two)

Health

General Depression/ unexplainable sadness

School & Academics

Other:

Required

Choose all that apply regarding your STRESS related to Social Media. (you can explain more in "other") *

I experience FOMO (fear of missing out)

I work very hard to get "likes" and to be an influencer.

I follow influencers or content that is negative

I spend hours binge watching/or/doom scrolling. It is soothing but I feel worse because of it.

I feel pressure from friends who are on social media (& keeping up with "likes") to stay popular

I feel bad about myself when I compare myself to others

I feel like I have to constantly post things (and look a certain way)

None of these apply to me

Other:

Required

10. Per month, how often do you sign up for something on-line, download something, or give your e-mail or address without knowing who was actually getting your personal information? *

Never, because I am always careful

Maybe just once by accident (1x per month)

I try to be careful but I am usually tricked into it maybe a few times a month (2-4 times a month)

I do it all the time because it is hard to avoid (5 or more times per month)

HOW MUCH MONEY A MONTH (approx.) do you spend on social media and apps? Including subscriptions and random purchases. (But not including your phone/data plan.) *

None

less than $10

$10-$25 / month

$25 - $50 / month

$50 -$75

$75 - $ 100

Over $100

Other:

11. Have you ever been in a car when the driver was so distracted by a phone that you were afraid they were not driving safely? *

Yes Often

Yes Sometimes

Maybe once

Never

Other:

Is distracted driving a problem? What would help with the problem of distracted driving. Choose all that reflect your opinion. *

It IS a big problem.

It is NOT a problem

Punnishment won't help the problem

Big Fines & Jail time if you cause an accident

Tech companies should be required to make phones inaccessible while driving

Other:

Required

12. Have you ever been involved in on-line bullying? (click all that apply) *

I was bullied (but it didn't go out of control because I had support of friends or family)

I was bullied (and it was horrible because I was completely alone.)

I stopped being a friend with someone because they were not popular and were the target of bullying.

I was a bystander (and never questioned the bully)

I stood up for someone being bullied. ("UPSTANDER")

I was a bully.

NEVER

Other:

Required

How often do you use filters when posting selfies to social media? *

Always

Sometimes

Never

14. When do you use your phone (or device) in school ?

Only when given permission and for school work only

Sometimes I use it secretly use it to text friends or family or use an app for fun

I can often use it for non-school work without getting caught

Other:

Clear selection

15. How much sleep each school night do you get regularly?

10 hours or more

8-10 hours

6 - 8 hours

5 - 6 hours

less than 5 hours

Other:

Clear selection

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