Grade Level: Age:
Encircle your answer
1. Is it okay for your parents if you engage in a romantic relationship at an early age? YES NO
2. Do your parents allow you to hang out with a person of the opposite sex? YESNO
3. Have you experienced engaging in a romantic relationship, if yes, continue, if no then skip questions 4-10.YESNO 4. Whenever you and your boyfriend/girlfriend are together, does it brighten your mood? YESNO
5. Which of these would you rather do to spend the whole night? Chat or text with your partnerStudy your lessons Do both 6. Do you go on romantic dates with your partner on school days? 7. Do you stay in school after dismissal or come in very early in order to spend time with your partner? YESNO
8. Does your girlfriend/boyfriend help you in your studies?
9. Do you talk to your girlfriend/boyfriend in class while the teacher is lecturing? YES NO
10. Do you share answers with your girlfriend/boyfriend whenever you’re doing your assignments or taking a test? YESNO
11. If you have to choose between studies and relationships, which of these two will you choose? STUDIESRELATIONSHIP WITH YOUR PARTNER
Answer if you only like someone but not you are not in a relationship with them 1. Do you think about your crush?
2. If yes, then how frequently?
Very Frequently Frequently SeldomVery Seldom
3. Do you feel motivated when you see your crush?
4. How many hours do you study?
5. Did your crush inspire you