Survey Example

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