You are on page 1of 1

NAME:

GRADE & SECTION:


Direction: Answer the question truthfully. All information you provide will be kept confidentially and
will be used only for academic research.
1. Have you ever engaged in online gambling activities?
YES NO

2. How frequently do you engage in online gambling activities?


DAILY
WEEKLY
MONTHLY
RARELY
NEVER
3. How much money do you typically spend on online gambling activities per week/month?
Please specify you’re answer: ________________
4. Have you ever missed a class or assignment due to online gambling activities?
YES NO
5. Have you ever received a lower grade on an assignment or exam because of time spent on online
gambling activities?
YES NO

You might also like