Dear Respondents,

Greetings!

We, the Earth group of IV-Charity, will be conducting a research study entitled “How does video games affect children and teenagers?”.  In partial fulfillment of the subject: Research II.

You were chosen as the respondents because of your related knowledge and experience. In accordance with this, kindly accomplish the questionnaire as honestly and accurately as possible. Rest assured that your anonymity and any of the information you will be treated with utmost confidentiality. All your response will be treated with utmost confidentiality.

May we also humbly request that the accomplished questionnaire will be returned to the researchers after you have completed answering all the items in the questionnaire.

Thank you very much for your cooperation and support!

Respectfully yours,

Neri, Lexus Oliver Jung, Shena Samilin, Angelica Researcher Researcher Researcher

Bestre, Steven Rey Researcher

Noted by:

Ma’am Jenica Joy P. Valerio Ma’am Eva S. Barrientos Research Adviser Principal

Name: _____________________________Sex: ___Date: _____________

I. Please check the box that best corresponds to your answer.Always Sometimes Frequentl

yOften Never

1. I stay up late just to play video games.

2. I cannot pay full attention to the teacher because I stayed up late the night before.

3. My grades went down because of my video gaming,

4. My teachers scold me because I sleep during class hours due to staying up all night playing video games

5. I go home late because I go to computer shops to play.

II. Check/Fill up the blanks that corresponds to your answer. (You may check more than one blank)

1. What websites do you visit?

FacebookYoutubeVimeoInstagramGoogleTwitterFlickrPinterest

2. What are the factors that affect your video gaming?

[ ] Peers

[ ] Family problems

[ ] Stress relief

[ ] Trend

[ ] To meet more friends

[ ] others: ____________________________________ (please specify)

3.How many hours do you play video games?

[ ] 1-2 hours

[ ] 2-3 hours

[ ] 4-5 hours

[ ] more than 5 hours

4.Have you ever got sick when playing the computer overnight?

[ ] Yes [ ] NoIf yes, please indicate :____________________

III. Answer the following honestly.1. When I play video games, I often ______________________________________2. When I go home late after playing video games, my parents ________________

___________________________________________ .3. When I fall asleep during class, my teachers often ________________________

__________________________________________________.IV. Characteristic:

Bad Attitudes that you got from playing video games:[ ] mood-swings[ ] trash-talker[ ] shouting[ ] “taong bahay”[ ] late sleeper[ ] saves money for computer shops[ ] doesn`t eat on time[ ] others:

Good Characteristics:[ ] friendly[ ] reaction time[ ] discipline[ ] optimistic[ ] others:____________________