Directions: For each person you survey, fill out one line. For each correct answer, write a check mark in the box. Write in any incorrect answers. If they don’t know the answer, write a question mark. After you complete each survey, give the teen a Snickers bar with a Snickers FAS Card. When you have filled up this sheet, provide all information requested at the bottom, and mail this to FAS Center ATPT #7, 4710 E. 29th St., Tucson, AZ, 85711. |
| Sex | Grade | Age | #1 | #2 | #3 | #4 | #5 | #6 | #7 | #8 | #9 | #10 |
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink | ||
| F/M | Alcohol | Alcohol | Alcohol | Fetal Alcohol Syndrome | None | All | Lifetime | Normal | All | Don't Drink |