SURVEY FORM

Name: ____________________________________Address: ___________________________

Note: Please answer this honestly.
1. What is your age when you start to be updated with the use of technology?
2. Do you find that you stay online or video game late at night?
Always

Often

Sometimes

Rarely

3. Do you neglect your assignments or projects to spend more time online or video gaming?
Always

Often

Sometimes

Rarely

4. Do you build new relationship with your online friends?

Always

Often

Sometimes

Rarely

5. Do others in your life complain to you about the amount of time you spend online?
Always

Often

Sometimes

Rarely

6. Do you check your messenger, E-mail, facebook or twitter before doing something?
Always

Often

Sometimes

Rarely

7. Does your school performance suffer because of Internet?

Always

Often

Sometimes

Rarely

8. Do you fear that life without the Internet would be boring?

Always

Often

Sometimes

Rarely

9. Do you feel irritated when someone disturbs you while you are online?
Always

Often

Sometimes

Rarely

10. Do you try to lessen your time in using the internet but you fail at the end?
Always

Often

Sometimes

Rarely

What do you think is the prevention if you are addicted to internet?

How can you lessen your time in using the internet?