Name:

Sex: Male Female

Grade: Freshman Sophomore/Junior Senior

Health problem? Yes No

Single Parent: Yes No

Parental Education: Primary school or below Secondary school University or higher

Socioeconomic Status: 1 (Low) 2 3 (High)

Residential Area: 1 (Underdeveloped) 2 (Developed) 3 (Highly developed)

Minority: 1 (Immigrant/refugee) 2 (Parental Immigrant/refugee) 3 (Indigneous origin) 4 (None)

Parental Health Problems? Yes No

Siblings:

Activity rate after school? (Extracurricular) 1 (Low) 2 3 4 5 (High)

Absenteeism:

Grades: 1 (Low) 2 3 4 5 (High)

Grade Retention: 1 (Low) 2 3 4 5 (High)

Number of violence incidents at school:

Bad attitude: 1 (Never) 2 3 4 5 (Often)

Bullying: 1 (Never) 2 3 4 5 (Often)

Caught with prohibitied substinances: 1 (Never) 2 3 4 5 (Often)

Delinquecy: 1 (Never) 2 3 4 5 (Often)