Republic of the Philippines

Eastern Visayas State University

Tanauan Campus, Tanauan, Leyte

SURVEY QUESTIONNAIRE
ALCOHOL CONSUMPTION AND ACADEMIC PERFORMANCE AMONG
TECHNOLOGY STUDENTS

November 15, 2019

Dear Respondents:

Greetings!

The undersigned researcher is presently working on a research paper entitled

“ALCOHOL CONSUMPTION AND ACADEMIC PERFORMANCE AMONG

TECHNOLOGY STUDENTS”. In view of this, the researchers have chosen you as one

of their respondents. Rest assured that all the information obtained will be treated with

utmost confidentiality.

Your sincere help would make this paper more meaningful and a success.

Sincerely yours,

Melchanitte Beriso

Ma. Cecelia Garcia

Zyjen Laurona
Part I: Respondent’s Profile

Direction: The following questions ask you about your personal information. Please

answer the following questions by putting a check (R) mark in the box or provide the

information being ask.

1. Respondents Name (optional) ______________________________

1.1 Age: ___

1.2 Course, Year & Section: ____________________

1.3 Sex:

Male

Female

1.4 Type of Drinker

Light

Moderate

Heavy

1.5 Kind of Alcohol Intake

Low alcohol beer

Ordinary strength beer

Wines or sparkling wines

 RTD’s (Ready to drinks)

Low alcohol spirits mixed or straight

Full strength spirits mixed or straight

Part II: Status of Drinking Alcohol

Direction: Read questions as written. Record answers carefully. Your answers will

remain confidential so please be honest. Put a check (R) mark that best describes your

answer to each question.

Scale Interpret

1 Strongly Disagree
2 Disagree
3 Neutral
4 Agree
5 Strongly Agree
 Statement 5 4 3 2 1
A. Reasons for taking alcohol
1. Curiosity

2. Academic Stress
3. Peer Pressure
4. Adult Influence
5. To help with sleep
6. To escape problems, loneliness and
depression.
7. Wasn’t able to meet work
commitments.
8. Felt unsafe

9. Wasn’t able to meet family

responsibilities
10. Got into a fight (violence,
aggression)

B. Frequency of taking alcohol

1. Everyday
1. At least once a week but not
everyday
2. Atleast once a month but less than
once a week
3. More than once a year but less than
once a month
4. Once a year or less

C. Volume of alcohol intake per

session

1. Over 6 drinks
2. 5 or 6 drinks
3. 3 or 4 drinks
4. 1 or 2 drinks
5. Less than 2 drinks

D. Cost of alcohol per session