Personal Information

Name: _____________________________________________
Age : ___________ Sex : ____________ Grade level: _____________________
Direction: Put a check (√) under the column of your answer; YES column if you agree to
the following question, NO column if you disagree and MAYBE column if you are
hesitating.
QUESTIONS YES NO MAYBE
1 .Do you think mobile game affects your attitude and
behavior?
2. Do you agree that playing mobile games can affect the
academic performance of every student?
3. Do you think mobile games can improve social relationship
among students?
4. Do mobile games affect your time with your family?
5. Do you think the bad effects of mobile games are enough
reason for students like you to control and limit your time in
gaming?
6. Do you skip your meals just to finish your online game?
7. Do you consider yourself an addicted gamer?
8. Do you experience any health problems because of
excessive mobile gaming?
9. Do you prefer playing mobile games rather than physical
games?
10. Do you think mobile game could affect your physical and
mental health?
11. Do you lose hours of sleep at night because of playing
mobile game?
12. Did you experience being late or absent classes because of
playing mobile game?
13. Are you guilty and ashamed because of being addicted to
mobile game?
14. Does mobile game made you think better and sharper?
15. Have you lost contact with friends and family because of
gaming?

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RESPONDENT SIGNATURE