Questionnaire

Good Day! We, Grade 12-ABM/GAS students of Saint Jerome Integrated School of Cabuyao
conducting a study entitled “Alcohol Consumption and Teenage Behavior” In line with this, may we
request for your kind cooperation by answering this questionnaire. Rest assure that all the information will
be used for study purposes only. This will be a big help in contributing data to our study. Thank you!
Sincerely,
The Researchers
Name (optional): _______________
Age: _______________
Gender (male/female) _______________

INSTRUCTIONS
1. Refer to the attached research instrument for validation
2. Please use the rating scale
4 - Strongly Agree
3 - Agree
2 - Strongly Disagree
1 - Disagree
Part I: This part aims to assess the level of alcohol consumption by the teenage students. Please
read carefully and put a check (√) mark on the appropriate column that corresponds to your answer.

I... 4 3 2 1
1. prefer drinking alcohol than other beverages.

2. only drink alcohol occasionally.

3. drink alcohol even without occasions.

4. drink alcohol to bond with friends.

5. have a high tolerance for alcohol.

Part II: This part aims to assess the level of manifestation of behavior by students. Please read
carefully and put a check (√) mark on the appropriate column that corresponds to your answer.
A. Academic Performance

I... 4 3 2 1
1. miss classes because of consuming alcohol.

2. can’t actively participates in school activities or lectures.

3. fell asleep during class.

4. normally spend my time drinking than reading our future lessons.

5. am not able to pass my written works and performance tasks on time.

B. Behavior at Home

When I consumed alcohol, I… 4 3 2 1

1. became naughty.

2. became irritated and short tempered.

3. rather spend my time at room than to talk or to bond with my siblings.

4. spent most of my time sleeping or laying on the bed.

5. fight with my siblings.

C. Social Behavior

When I consumed alcohol, I… 4 3 2 1

1. can express my thoughts and feelings.

2. became confident in talking with other people.

3. became extrovert person.

4. became funny.

5. am able to meet new friends.