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BAGUIO CITY INDEPENDENT SURVEY 2016

NAME
Last Name First Name Middle Name
ADDRESS/BARANGAY
OCCUPATION SEX AGE REGISTERED VOTER v YES v NO

1. RELIGIOUS AFFILIATION

□ Catholic □ Baptist/ Protestant


□ Iglesia ni Cristo □ Born Again Christian
□ Seventh Day Adventist □ Others, please specify:
□ Islam __________________

2. EDUCATIONAL ATTAINMENT

□ Elementary □ College
□ High School □ Vocational
□ College Undergraduate

3. ETHNICITY

□ Ibaloi □ Ifugao
□ Ilocano □ Visayan
□ Kanakanaey □ Mindanao
□ Kapampangan □ Other Cordilleran Tribes
□ Mountain Province □ Others:

4. MAIN SOURCE OF INCOME

□ Salaries/ Wages □ Private Business


□ Remittance □ Others, please specify

5. WHAT ARE YOUR SOURCES OF INFORMATION?

□ NEWSPAPERS(Local, □ FAMILY CLAN


National)
□ RADIO □ CIVIC GROUPS
□ NATIONAL TV □ OTHERS, Please specify
□ LOCAL CABLE TV __________________
□ SOCIAL MEDIA

6. WHAT WOULD BE YOUR BASIS IN CHOOSING A LEADER?

□ Education □ Religious Affiliation


□ Family’s Choice □ Wealth
□ Family Name □ Work Experience
□ Family Friends □ Age
□ Platform □ Others, please specify:
□ Popularity __________________
7. WHAT IS/ ARE THE ISSUE/S CONCERN/S THAT YOU WANT TO BE ADDRESSED?
(RANK YOUR CHOICES ACCORDING TO WHAT IS MOST IMPORTANT, 1 AS THE MOST IMPORTANT)

□ Peace and Order □ Graft and Corruption


□ Education □ Squatters
□ Environment □ Water
□ Gambling □ Peddling
□ Garbage □ Transportation
□ Traffic □ Roads and Highways
□ Health

8. IF ELECTIONS WERE CONDUCTED TODAY, WHO ARE YOU GOING TO CHOOSE?

PRESIDENT (Select 1 only)


□ Binay, Jejomar □ Roxas, Mar
□ Duterte, Rodrigo □ Santiago, Mirriam
□ Poe, Grace □ Others: _______________

VICE PRESIDENT (Select only 1)


□ Cayetano, Allan Peter □ Marcos, Bongbong
□ Escudero, Francis □ Santos, Vilma
□ Estrada, Jinggoy □ Trillanes, Antonio
□ Robredo, Leni □ Others: ________________

SENATORS (Please select at least 5 or at most 12 only)


□ Arenas, Rosemarie □ Osmena, Sergio III
□ Atienza, Lito □ Pacquiao, Manny
□ Aquino, Bam □ Pangilinan, Francis
□ Bautista, Herbert □ Recto, Ralph
□ Cayetano, Lino □ Rodriguez, Rufus
□ De Lima, Leila □ Romualdez, Ferdinand
□ Drilon, Franklin Martin
□ Gatchallian, Sherwin □ Sotto, Tito
□ Guingona, Teofisto III □ Tiangco, Toby
□ Gordon, Richard □ Tolentino, Francis
□ Kiram, Jacel □ Tupas, Niel Jr.
□ Lapid, Mark □ Villanueva, Joel
□ Marcos, Ferdinand Jr. □ Villar, Mark
□ Moreno, Isko □ Zubiri, Juan Miguel
□ Moreno, Alma □ Others:__________________

CONGRESSMAN (Select only 1)


□ Aliping, Nicasio □ Go, Mark
□ Avila, Edgar □ Olowan, Faustino
□ Bautista, Peter Rey □ Vergara, Bernardo
□ Others: ________________

MAYOR (Select only 1)


□ Claravall, Del □ Molintas, Jose
□ Domogan, Mauricio □ Others:___________________

VICE MAYOR (Select only 1)


□ Bilog, Edison □ Olowan, Faustino
□ Bagbagen, Fred □ Tabanda, Lourdes
□ Carino, Richard □ Tabora, Antonio Jr.
□ Cosalan, Popo □ Others:__________________
COUNCILORS: (Select at least 6 or at the most 12 only)
□ Alangsab, Joel □ Nevada, Endong
□ Allad-iw, Arthur □ Nialla, Nick
□ Balajadia, Erdolfo □ Orate, Renan
□ Balisong, Rocky □ Orca, Virgilio
□ Balisong, Evelyn □ Ocampo, Rob
□ Baquirin, Raye □ Olowan, Faustino
□ Bomogao, Benny □ Olarte, Jo
□ Bumanglag, Villamor □ Ocampo, Rob
□ Cabato, Jojo □ Ortega, Roberto
□ Cayat, Garry □ Pangilinan, Lito
□ Cayabas, Vladimir □ Paraan, Ron
□ Datuin, Elmer □ Paraan, Rudy
□ De Castro, Abe □ Perez, Ron
□ De Castro, Marlene □ Rondez, Pinky
□ Dicang, Van □ Sembrano, Elaine
□ Farinas, Lilian □ Tabora, Antonio Jr.
□ Fianza, Peter □ Ueda, Eric
□ Gearlan, Glenn □ Vergara, Jonathan
□ Macadangdang, Benjie □ Wasing, Peter
□ Mandapat, Federico Jr. □ Weygan-Allan, Phillian
□ Maskay, Benny □ Yangot, Leandro
□ Mayos, Grace □ Yang-ed, Marvin
□ Mazo, Allan □ Yaranon, Lillian
□ Mendoza, Perry John □ Others:_________________

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