FORM NO. ____ PERCEPTION ON HB 4244 Good Day!

Thank you very much for agreeing to participate in our study. We are students in De La Salle University taking up a course on Family and Population. In partial fulfillment of our course requirements, we are conducting a survey on College Student Perception of HB 4244. Rest assured that all information shared will be kept confidential. If you have any questions, please feel free to ask the person who administered this survey to you. DIRECTIONS: Place a check mark on your choice of answer. Please write down your answer when asked to specify. Follow the directions as indicated per question . Please do not skip pages. Thank you.

A. Personal Information A1. Name (Optional)_________________ A2. Sex X Male A3. Age18 A4. Religion: Roman Cathloic A5. Race: Malay A6. Nationality X Filipino Female

Non-Filipino (Pls. Specify): ______________ Dual Citizen (Pls. Specify): _____________ A7. Current School Attended: University of Santo Tomas A8. Years in College 1st year 2nd Year 3rd Year A9. Degree Program : BS Pharmacy A10. Marital Status of Parents: X Married Separated A11. Number of Siblings:3 Single Parent Widow/Widower X 4th Year 5th Year 6th Year 7th Year

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A12. Monthly Household Income Under Php 50,000 Php 50,001 to Php 100,000 Php 100,001 to Php 200,000 Php 200,001 to Php 300,000 X Php 300,001 to Php 400,000

Php 400,001 to Php 500,000 Above Php 500,000

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B. Values Profile B1. Who teaches you values? Check all that applies. X Father X Mother Sister Brother Grandfather Grandmother X Aunt X Male Cousins X Female Cousins X Male Friends X Female Friends X Teachers Counsellors X Priests/Pastor Others (Pls. Specify below): _____________________ _____________________ _____________________ _____________________ _____________________

X Uncle

B2. Who among your choices from the previous question is the most influential to your life? Father B3.What Values have you learned from him/her?

X Good Manners Proper Dress Code Religious Beliefs X How to handle your relationship Acceptance of all kinds of People
C. HB 4244 C1. Do you know about HB 4244?

X Responsibility for your Actions Helping in the Community X Conforming with rules X Knowledge is power

Others: (Pls. Specify Below) ________________ ________________ ________________ ________________ ________________

Yes (Proceed to page 4)

X No (Proceed to page 5 )

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C2.Where did you find out about HB 4244? Internet Television Radio Newpaper Others (Pls. Specify): _________________ C3. Based on your knowledge, what are the provisions of HB 4244? (Check all that applies)

Family Planning Reproductive Health Abortion Sex Education Provisions for Prostitution Employer Responsibilities Provisions for Rape Victims

Reproductive Health Programs for Persons with Disabilities Access to Reproductive Health Information Accessibility of Reproductive Health Services

C4. Should Congress Pass HB 4244? Yes No Undecided Dont Care

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D1. Do you know about the RH Bill? X Yes (Proceed to D2) (End of Survey)

No

D2. Where did you find out about RH Bill? Internet X Television Radio X Newpaper

Others (Pls. Specify): _________________ D3. In your knowledge, what are the contents of RH Bill? (Check all that applies)

X Family Planning X Reproductive Health X Abortion X Contraceptives X Sex Education Prostitution Employer Responsibilities

Provisions for Rape Victims Reproductive Health Programs for Persons with Disabilities X Access to Reproductive Health Information X Accessibility of Reproductive Health Service

D4. Should Congress Pass the RH Bill? Yes X No Undecided Dont Care

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