Substance Use Survey - Parent Version
Does your child need support with substance abuse? We are offering a 4-week in-school prevention program for students in need of support. Each session is 1 hour.

Boston Collegiate Charter School is partnering with The Ostiguy Prevention Project, to help provide support and resources to any students who may be experiencing trouble with substance abuse. The Ostiguy Prevention Project responds to the impact of substance use and abuse among Boston high school students by providing evidence-based education, prevention, and early intervention services as well as access to pro-social enrichment activities. Please complete this survey if you'd like to recommend your child for this opportunity.

The following questions will ask about your child's use, if any, of alcohol, tobacco, and other drugs. Please answer every question honestly by checking the box next to your choice, or writing in the available text box. This survey is NOT anonymous, and will only be used to best support students who have been impacted by substance use. There will be NO consequences issued to students if you indicate substance usage.  


Email *
Student's Full Name *
Parent/Guardian's Full Name *
Student's Grade Level *
How long has your child used an E-cigarette or vape? *
How often does your child use E-Cigarettes or Vape? *
How long has your child used alcohol? *
How often does your child use/drink alcohol? *
How long has your child used marijuana/weed? *
How often does your child use/smoke marijuana/weed? *
Is your child concerned or worried by their substance use? *
Are YOU concerned or worried by your child's substance use? *
Does your child feel bad or guilty about their substance use? *
Do you feel your child's substance use impacts their ability in school (Grades, Attendance, Ability to concentrate, etc.)? *
Do you feel your child's substance use impacts their relationships (Family/ Friends, etc.)? *
Do you feel your child's substance use impacts their body (Athletic Performance/ Physical Health)? *
Do you feel your child's substance use impacts their mental health (Mood, Ability to process emotions, etc.)? *
If you answered "Yes" or "Somewhat" to the above questions about substances impacting your child's life, would you like to explain how?
Are you interested in your child participating in a 4 week long substance use prevention program facilitated by Ostiguy High? *
Do you have any questions about the Ostiguy High substance use prevention program? *
See the picture below for contact information on the Ostiguy Prevention Project
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