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