What name do you want to go by?

1. Who can you talk to when you need help?
(Please Select) a best friend a group of close friends no one aquaintances parents pet counselor Other:

2.Who are you around most?
(Please Select) a large group of aquaintances a best friend group of close friends parents I am not around people often another adult Other:

3.The thing that bothers me the most is:
(Please Select) grades what my friends do my parent's rules not being able to do things boredom guy/girl problems Other:

4.What feels most important to you right now?
What me and my friends do
watching TV and going on the internet
a guy/girl
grades
i don't know
being with parents
Other:

5. What are you worried about right now? (Please Select) a guy/girl liking me making some sort of mistake peer pressure what people think about me grades being accepted
Other:

6.What issue do you think is most important for teens at this very second? (Please Select) peer pressure what drugs do to you sex being accepted Other:

7. What is your pet peeve?

8. How old are you

9. I am a male female

10. What do you wish you knew right now?

Other comments on what's important to you: