Name(optional): _____________________ Age: __
Gender: __
INSTRUCTIONS: Encircle the letter of your choice. All information will be kept confidential and will be used for research purposes only. 1.) How often do you visit social networking sites? A.) Always B.) Never C.) Sometimes D.) Occasionally 2.) How much time do you spend on visiting social networking sites? A.) 30 mins. – 1 hr. B.) 1 hr. – 2 hrs. C.) 2hrs. – 3 hrs. D.) Others (Pls. specify): _________________ 3.) Do you enjoy visiting social networking sites? A.) Yes B.) No C.) Sometimes 4.) If Yes or Sometimes in number 3, what do you enjoy about social networking sites? A.) Communication B.) Meeting people C.) Games D.) Others (Pls. specify): ______________ 5.) Do you get tired after visiting social networking sites? A.) Yes B.) No C.) Sometimes 6.) What time do you usually sleep at night? A.) 10:00pm B.) 11:00pm C.) 12:00mn D.) Others (Pls. specify): ________________
7.) Does it affect your studies? A.) Yes B.) No C.) Sometimes D.) Mostly 8.) If Yes or Sometimes, how does it affect your studies? A.) I get distracted in school B.) I get low grades C.) I cant focus on my lessons D.) It makes me lazy E.) Others (Pls. specify): _________________ 9.) Do you prefer social networking sites more than studies? A.) Yes B.) No C.) Maybe 10.) If Yes or Maybe, why? A.) I can express myself B.) I don’t care about my studies C.) I enjoy it D.) Its more important E.) Others (Pls. specify):