Arizona Youth Risk Behavior Survey Template Page 2
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146.
How tall are you without your shoes
Directions
on?
Use a #2 pencil only.
Directions: Write your height in the shaded
Make dark marks.
blank boxes. Fill in the matching oval below
Fill in a response like this: A B
D.
each number.
If you change your answer, erase
your old answer completely.
Example
Height
1.
How old are you?
Feet
Inches
A.
12 years old or younger
5
7
B.
13 years old
C.
14 years old
D.
15 years old
E.
16 years old
F.
17 years old
G.
18 years old or older
2.
What is your sex?
A.
Female
B.
Male
3.
In what grade are you?
A.
9th grade
1 1
B.
10th grade
C.
11th grade
D.
12th grade
7.
How much do you weigh without
E.
Ungraded or other grade
your shoes on?
Directions: Write your weight in the shaded
blank boxes. Fill in the matching oval below
4.
Are you Hispanic or Latino?
each number.
A.
Yes
B.
No
Example
Weight
What is your race? (Select one or
5.
Pounds
more responses.)
1
5
2
A.
American Indian or Alaska
Native
B.
Asian
C.
Black or African American
D.
Native Hawaiian or Other
Pacific Islander
E.
White
-2-
2013 Arizona YRBS
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Parent category: Life