Direction: The following questionnaire asks you about your personal information.

Please answer

the following questions by putting a check (/) mark in the parenthesis or providing the information

being ask.

A. Respondents Name (optional) ________________________________________

I.D Number____________________
1. Age:______________________________
2. Sex: ( ) Male ( ) Female
B. Drinking habits of the Respondents:
1. Kinds of liquors:
( ) Non-drinker
( ) Beer ( ) Gin
( ) Red horse ( ) Wine
( ) GSM, Mojeto, Coffee ( ) Tuba or Wine
( ) Emperador ( ) Tanduay Ice
( ) The BAR
( ) Other, Please specify__________________________________

2. Numbers of Bottles that consumed per week.

( ) Non-drinker
( ) 1-2 Bottles
( ) 3-4 Bottles
( ) 4-5 Bottles
( ) 5-6 Bottles
( ) Others, Please specify__________________________________

3. How much do you typically pay for one alcoholic drink?

( ) Non-drinker
( ) Nothing, it is typically free
( ) Under ₱50.00 to ₱ 100.00
( ) Under ₱150 to ₱ 200.00
( ) Under ₱250 to ₱ 300.00
( ) Under 350.00 to 400.00
( ) others, please specify___________________________________
(Please fill in amount.)
5. Where do you usually drink?
( ) Non-drinker
( ) Home
( ) Near School
( ) BAR/station
( ) Others, please specify___________________________________
6. What time do you usually drink?
( ) Non-drinker
( ) Morning
( ) Noon time
( ) Night time
( ) Others, please specify____________________________________

7. What is the reason why are you drinking?

( ) Non-drinker
( ) To have a good performance in classroom
( ) Because I’m broken hearted
( ) To join friends in socializing
( ) To relax after a hard day
( ) To taste the alcohol drinking
( ) For physical effects
( ) Because it’s an important part of our culture
( ) To have a good sleep
( ) Other, please specify________________________________________

8. How would you best describe yourself in terms of your current use of alcohol?
( ) Non-drinker
( ) Abstainer
( ) Abstainer — former problem drinker in recovery
( ) infrequent drinker
( ) Light drinker
( ) Moderate drinker
( ) Heavy drinker
( ) Problem drinker
( ) 0thers, please specify_________________________________
THANK YOU FOR BEST ANSWERING THE QUESTION!