I. Profile Direction: Answer the following by putting a check mark on the space provided that corresponds to your answer.

1. Age [ ] Below 12 [ ] 12 [ ] 13 2. Sex [ ] Male 3. Year Level [ ] Freshman [1st Year] [ ] Sophomore [2nd Year] 4. Section: ______ 5. Average Daily Allowance [ ] P20 and below [ ] P21 P30 [ ] P31 P40 6. Estimated Monthly Family Income [ ] below P5,000 [ ] P5,001 P10,000 [ ] P10,001 P15,000 [ ] P15,001 P20,000 [ ] above P20,000

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] 14 ] 15 ] 16 and above

] Female

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] Junior [3rd Year] ] Senior [4th Year]

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] P41 P50 ] above P50

II. Social Issues Please check the corresponding bracket that shows your degree of agreement with the following statements. 5 Strongly agree 4 Agree 3 Undecided 2 Disagree 1 Strongly disagree

5 A. SOCIAL ISSUES 1. Early Pregnancy/Teenage Pregnancy a. Early pregnancy is rampant in our school. b. I am a victim of early pregnancy. c. There are cases of early pregnancy in our class/section. 2. Vices [smoking, drugs, drinking alcohol, gambling, cutting classes] a. Vices are rampant in our school. b. I am a victim of one/some/all of these vices. c. There are students in our class/section who have one/some/all of these vices. 3. Fraternities/Sororities a. Fraternities and sororities are rampant in our school. b. I am a member of a fraternity/sorority. c. There are students in our class/section who are members of fraternities/sororities. 4. Juvenile Delinquency a. Juvenile delinquency is rampant in our school. b. I have been involved in a crime. c. There are students in our class/section who have been involved in crimes.

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5 B. CAUSES OF SOCIAL ISSUES 1. Family a. I receive my allowance regularly. b. My parents income is enough for my family needs. c. My parents have the means to send me to school. d. My parents can provide the needs of our family. e. My parents can buy anything I need in school. f. Parents guidance is properly given to me. g. My parents are proud of my achievements in school. h. My parents show appreciation for my efforts in school. i. My parents know if I have academic problems. j. They see to it that I study my lessons regularly. k. They are interested to let me finish my studies. l. My parents help me do my assignments. m. My parents practice fair treatment. 2. Peer Pressure a. I spent most of my time with my friends than with my family. b. I imitate most of the things my friends do. c. My friends introduced me to the social issues [early sexual activity, vices, fraternities, juvenile delinquency] common to the youth. d. I seek their company whenever the attention I need from my family is not provided to me. e. Values prevail even though my friends are forcing me to try one/some/all of the social issues common to the youth.

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5 3. a. have house. b. I usually bully my classmates because I want their attention to be focused on me. 4. Media a. I usually download pornographic videos and store them in my phone. b. I am influenced heavily by TV programs which contain sensitive scenes / brutal scenes. c. I love to join text clans to find a boyfriend / girlfriend. d. I use social networking sites to make friends online and chat with online users. e. I use the internet as a medium to watch pornographic videos. Domestic Violence I am being beaten / I been beaten in our [ ] [

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C. PROGRAMS THAT RESPOND TO SOCIAL ISSUES Our school has implemented programs, such as: a. Sex education, tackling how early pregnancy can be prevented, the bad effects of early experience in sex, and the bad effects of early motherhood/fatherhood. b. School-based tobacco education and preventive programs, which educate students about the real dangers of smoking, prepare students to resist the offer of cigarette smoking, and prevent and reduce cigarette smoking among students.

c.

School-based drug and alcohol prevention programs, which teach students how to resist peer influences, improve generic life skills, involve families, and provide opportunities to become involved in positive experiences with others in the school and community. d. Contests / competitions [such as poster-making contest, debate, etc.] to improve the intellectual and social development of students.