HEADSTART COLLEGE OF COTABATO

Japal Guani Sr. Street

Cotabato City

LETTER TO THE RESPONDENT

September 30, 2019

Dear Respondents

You are one of the very few individuals selected for the present study
entitled “The Effect of Drinking alcohol toward the academic performance of
student of Headstart College Cotabato”

Please answer the question in this survey from as completely as

possible. All your answer will keep in strict condolence. No one will know your
responses since they will do coded to protect your identity

Your cooperation in accomplishing this form will be of great help in the

partial fulfillment of the course Crim Socio 7: Criminological Research and Statistics will
be highly appreciated.

Thank you very much for great assistance.

Very truly yours,

Zcesar Ian D. Candaroma

John Paul D. Caceres
Rachel Caliangga

Reaserchers
Noted by

Samad B. Anong
Adviser
__________1.Have you ever passed out or experienced memory loss due to drinking? (blackout)

__________2.Were you ever sexually taken advantage of while under the influence of alcohol?

__________3. Have you ever sexually taken advantage of someone else while they were under
the influence of alcohol?

__________4. Do you ever drive after drinking going to school?

__________5. Do you drink to feel good/to function better during class hours?

__________6. Do you have a history of alcohol or drug problems in your family?

__________7.Have you ever become violent or aggravated while drinking before going to
school?

__________8. Do you drink to escape pain, either physical or emotional?

__________9.Have you ever skipped or missed class because of drinking?

__________10. Have you ever gotten into trouble at school because of drinking?
 The Effect of Drinking Alcohol towards the Academic Performance of students
of Headstart College of Cotabato.

SURVEY QUESTIONNAIRE

Part I: Socio-demographic Profile

Direction : Fill – in what is asked in each item.

Name (optional) :___________________________________

Gender :___________________________________

Age :___________________________________

Year level :___________________________________

Religion :___________________________________

Part II : The effect of drinking alcohol.

Direction: The following are statements on the Effect of Drinking Alcohol towards the
Academic Performance of student of Headstart College of Cotabato. Kindly read each
statement and right your responses on the space provided with your understanding on it
based on the following rating scale.

5-Strongly agree
4-Agree
3-Uncertain
2-Strongly disagree
1-Disagree