Are you Male or Female?

Male
Female

What grade are you in?

Grade 9
Grade 10
Grade 11
Grade 12

How often do you spend time violent watching movies, television, playing video games, etc., in a week?

1-3 hours
4-7 hours
8-10 hours
10 +

When watching these violent scenes in a movie or TV show, on a scale of 1(lowest) – 10 (highest), how exciting do you find them?

Have you ever been upset/frightened by violence witnessed in movies?

Never
Sometimes
Always

How much violence do you think there is on television?

Little Amount
Even Amount (Neutral)
Large Amount

When you are exposed to media violence (any act of violence in movies, television, video games, or music), do you tend to feel more aggressive afterwards?

Yes
No
Sometimes

Do you feel media violence (any act of violence in movies, television, video games, or music), plays a key role in the acts of violence executed by the youth today?

Yes
No

Do you think that playing violent video games or listening to violent music increases your aggression?

Yes
No
Sometimes

To what extent do you agree with this statement, “When I experience conflict with another, I confront them and I don't step down”

Strongly Agree
Agree
Strongly Disagree
Disagree

To what extent do you agree with this statement, “During conflict, I am most likely to yell, raise my voice, and possibly curse at the other person!”

Strongly Agree
Agree
Strongly Disagree
Disagree

If you were to witness another peer in an act of violence, what would you do?

Go and get involved in the act
Stand by and not do anything
Get a teacher/counsellor to help solve the situation

What kinds of TV shows and movies do you spend the most time watching? (You can pick up to three).

Dramas
Comedies
Cartoons
Action/Thriller
Other: (Please Specify):

In questions #14 and 15, please choose the phrase that you feel best completes the sentence.

The ratings (G, PG, etc.) for TV shows and movies

Helps teens/children to decide