Name: _____________________________ Grade/Year level: _____________
Age: _________ Gender: ( ) Male ( ) Female
1) What time do you usually arrive at school?
( ) 4:00AM – 5:00AM ( ) 6:00AM – 7:00AM ( ) 8:00AM – 9:00AM
( ) 5:00AM – 6:00AM ( ) 7:00AM – 8:00AM
2) What is the usual reason why you’re late?
( ) sleeping late ( ) no uniform ( ) mother woke up late
( ) lazy ( ) bathroom is occupied ( ) you forgot something
( ) you’re far away from home ( ) woke up very late
( ) traffic ( ) family emergency
( ) no transportation ( ) arguments with family
3) What time do you wake up for school?
( ) 5:00AM ( ) 6:00AM ( ) 7:00AM
( ) 5:30AM ( ) 6:30AM ( ) 7:15AM
( ) 5:45AM ( ) 6:45AM ( ) 7:30AM
4) What is the distance from your home to school?
( ) half a kilometer ( ) 7 km ( ) 11.5 km
( ) less than a kilometer ( ) 7.5 km ( ) others: ______
( ) 1.5 km ( ) 8.5 km
( ) 2.5 km ( ) 9 km
( ) 3 km ( ) 9.5 km
( ) 4.5 km ( ) 10 km
( ) 5 km ( ) 10.5 km
( ) 6.5 km ( ) 11 km
5) What activity do you do in the morning that takes a lot of time?
( ) eating breakfast ( ) changing your clothes
( ) brushing your teeth ( ) walk to school
( ) taking a bath ( ) preparing your things
( ) preparing your food ( ) drying your hair
( ) brushing your hair ( ) make lunch
6) What will you do to lessen the chances of being late? Mark your answers
( ) wake up early ( ) take a shower the night before
( ) minimize the time of your ( ) prepare an hour before school starts
Preparation ( ) travel 15 minutes or more before school time
( ) eat fast ( ) set up an alarm clock
( ) move to another house ( ) prepare the things needed for school the night before
near your school
7) What is your position in your family?
( ) Youngest ( ) 4th
( ) oldest ( ) only child
( ) 3rd [continues]
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