Survey Example

Topics: Alcoholic beverage, Drink, Emotion Pages: 4 (486 words) Published: March 12, 2013
Dear Respondents,
We the students of communication skills 14 are conducting a research paper regarding the causes and effects of smoking and drinking to 2nd year students of Centro Escolar University, Manila school year 2012-2013. Here are some questions below, please answer it by putting check on the answers provided before the line. Thankfully yours, (name of respondents) Researchers Questions For Drinkers:

1. Have you ever consumed alcohol?
__yes
__no
2. At what age did you start consuming alcohol? ________

3. . Why did you start consuming alcohol?
__ peer pressure
__family problems
__curiosity
__to have fun
Other(please specify____________)
4. Have you ever passed out or experience memory loss due to drinking? ___ yes
____no
5. What alcoholic beverages do you often drink?
____ beer
____ cocktails
____ rhum
____ whistkey
6. How often do you drink?
____ once a week
____ twice a week
____ once every two weeks
Others: (please specify) _____
7. Do you drink to escape pain, either physical or emotional? ___ Yes
___ No

8. How does it affect your condition the next day?
____ makes you lazy
____ makes you feel sleepy
____ makes you feel out of the mood
____ makes you feel sick
9. Have you ever skipped or missed class because of drinking?   ___Yes
___ No
10. How does it affect your performance in school?
____ gives you poor outcome in class participation
____ makes you feel lazy to come to class
____ makes you feel sleepy during class
____ gives you low grades
11. Have you ever skipped or missed class because of drinking?   ___Yes
___No
12. Did you ever get into...
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