Direction: Kindly put a check mark(s) on your answer.

I. Why do some teens drink alcohol at their age?

1. What is your gender?

___ Female ___ Male

2. Have you ever consumed alcohol?

___ Yes ___ No

3. How often do you drink?

___ everyday ___ only on weekends ___ 3-5 times a week ___ on special occasions ___ once a week

4. Estimate the number of hours you drank the last time you socialized.

___ 1 hour ___ 4-5 hours ___ 2-3 hours ___ more than five hours

5. How many drinks did you have during that time?

___ 1-2 ___ 7-9 ___ 3-4 ___ more than 9 ___ 5-6

6. Do you ever drink to get drunk? ___ Yes ___ No

7. Who influences you to drink?

___ friends ___ neighbor ___ family ___ cousins ___ classmates ___ others Specify: ________

8. Who are your companions when you’re drinking?

___ classmates ___ family ___ neighbor ___ friends ___ cousins ___ others