Feedback for the Adolescent Development Products and We Think Twice Digital Media Campaign

PAPERWORK REDUCTION ACT OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN The purpose of this information collection is to understand the perspectives and preferences of youth in order to inform the development of resonant products that can help them with healthy decision-making. Public reporting burden for this collection of information is estimated to take no more than 10 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0401 and the expiration date is 05/31/2027. If you have any comments on this collection of information, please contact RTI at wtt@rti.org.

Registration/Screener Questions for We Think Twice^TM Insider Recruitment

First name:

Last name:

What is your current gender identity? (Select ALL that apply)

• Male

• Female

• Transgender Male/Transman/FTM

• Transgender Female/Transwoman/MTF

• Genderqueer

• Another category

• Prefer not to answer

Date of birth:

What sex were you assigned at birth? (Select one)

• Male

• Female

• Prefer not to answer

Zip code:

What is your race and/or ethnicity?

Select all that apply.

 American Indian or Alaska Native

For example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation

of Montana, Native Village of Barrow Inupiat Traditional Government,

Nome Eskimo Community, Aztec, Maya, etc.

 Asian

For example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.

 Black or African American

For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.

 Hispanic or Latino

For example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.

 Middle Eastern or North African

For example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.

 Native Hawaiian or Pacific Islander

For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.

 White

For example, English, German, Irish, Italian, Polish, Scottish, etc.

What type of school do you attend?

• Public

• Private

• Charter

• Boarding

• Other

Tell us something about yourself

Age:

Gift Card Preference

• Starbucks

• Amazon

• iTunes

For some Insider activities, we’ll be asking about your ideas and experiences. Can we quote you on our website and/or social media page?

• Yes, you can quote me anonymously

• No, you cannot quote me