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Alcoholism Impact on Grade 11 Students

This document is a questionnaire designed to assess the effects of alcoholism on Grade 11 students at Munguia Senior High School. It includes sections on demographic information, alcohol consumption patterns, academic performance, health and social impact, and awareness of support programs. The responses will be confidential and used for research purposes.

Uploaded by

Maria Cristina Ilayat
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12 views4 pages

Alcoholism Impact on Grade 11 Students

This document is a questionnaire designed to assess the effects of alcoholism on Grade 11 students at Munguia Senior High School. It includes sections on demographic information, alcohol consumption patterns, academic performance, health and social impact, and awareness of support programs. The responses will be confidential and used for research purposes.

Uploaded by

Maria Cristina Ilayat
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Questionnaire: The Effects of Alcoholism on the

Studies of Grade 11 Students at Munguia Senior High


School

Instructions:

 Please answer all questions honestly.


 Your responses will be kept confidential and used solely for research purposes.
 Mark your answers with a check (✔) where applicable or provide written responses as
requested.

Part 1: Demographic Information

1. Age:

o 15-16
o 17-18
o 19 or older

2. Gender:

o Male
o Female
o Prefer not to say

3. Living Situation:

o With parents
o With relatives
o Alone
o Other: _______

4. Do you have a part-time job?

o Yes
o No
Part 2: Alcohol Consumption Patterns

1. Have you consumed alcohol in the past year?

o Yes
o No

If yes, how often do you consume alcohol?

o Rarely (less than once a month)


o Occasionally (1-3 times a month)
o Regularly (weekly or more)

2. What is the primary reason for consuming alcohol? (Select all that apply)

o Peer pressure
o Stress relief
o Curiosity
o Social gatherings
o Other: _______

3. Do you usually drink alone or in a group?

o Alone
o In a group

Part 3: Academic Performance

1. Have you noticed any changes in your academic performance since you
started consuming alcohol?

o Yes
o No

If yes, what changes have you noticed? (Select all that apply)

o Decreased focus during classes


o Poor academic performance (lower grades)
o Increased absenteeism
o Difficulty completing assignments
o Other: _______

2. How often do you miss school because of alcohol-related reasons (e.g.,


hangovers, fatigue)?

o Never
o Rarely
o Occasionally
o Frequently

Part 4: Health and Social Impact

1. Do you feel alcohol consumption affects your mental or physical health?

o Yes
o No

If yes, what effects have you noticed? (Select all that apply)

1.

o Fatigue
o Anxiety or depression
o Poor memory
o Difficulty concentrating
o Other: _______

2. Has alcohol consumption affected your relationships with classmates,


teachers, or family members?

o Yes
o No

Part 5: Awareness and Solutions

1. Are you aware of any programs or support groups at Munguia Senior High
School addressing alcohol-related issues?

o Yes
o No
2. Do you believe alcohol consumption is a problem among Grade 11 students
at your school?

o Yes
o No

3. What measures would you suggest to help students avoid alcohol-related


issues? (Open-ended)

4. Would you be willing to participate in awareness programs about the effects


of alcoholism?

1.

o Yes
o No

Thank you for your time and cooperation!

4o

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