Republic of the Philippines

Department of Education
GONZAGA NATIONAL HIGH SCHOOL
Smart, Gonzaga, Cagayan

Part I- Background of the Respondents

Name (Optional) ____________________________________________

Age: __ Gender at Birth: ____________________

Occupation: __________________ Religion: ________________

Your Current Sexual Orientation/Preference: Please put (  ) checkmark.

___Gay ___Lesbian ___Bisexual ___Transgender ___Queer

Educational Level: Please put ( ) checkmark.

___Primary Undergraduate ___Primary Graduate

___Secondary Undergraduate ___Secondary Graduate

___Vocation/Diploma Undergraduate ___Vocational/Diploma Graduate

___College Undergraduate ___College Graduate

___Master Degree (Undergraduate/On going) ___Master Graduate

___Doctorate Degree (Undergraduate/On going) ___Doctorate Graduate

___: Your age when you knew that you have different sexual orientation.

___: Your age when you finally revealed your sexual orientation.

(If not yet put “X” mark which will signify you are discreet)

Part II- LGBTQ Language

Please put () check mark if you agree and (X) mark if you disagree to the following benefits
and uses of LGBTQ Language.

___ It describes the self-expression towards one’s interests

___It portrays self-acceptance in the LGBTQ group.

___It shows belongingness in the LGBTQ group.

HUMANITIES AND SOCIAL SCIENCES

 Republic of the Philippines
Department of Education
GONZAGA NATIONAL HIGH SCHOOL
Smart, Gonzaga, Cagayan

___Used to communicate with other member in LGBTQ group.

___Used to communicate with other non-member in LGBTQ group.

(Please list down if there is any benefits and uses of LGBTQ Language )
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Form of Language
Please write down how you form different language or slang in LGBTQ community.
______________________________________________________________________________
______________________________________________________________________________

Part III. Intimacy and Engagement

Please write you answer honestly.

___ Your age when you had your first relationship with same gender (if any).

___ Your age when you had your first relationship with opposite gender (if any).

___ How many relationships you had with same gender (if any).

___ How many relationships you had with opposite gender (if any).

___ How long did your first relationship lasted with the same gender (if any).

___ How long did your first relationship lasted with opposite gender (if any).

Please put () check mark on how you find a possible partner.

___ Through Social media (FB, Twitter, etc).

___ Through extracurriculars in school/community.

___ Through friends in school /community.

___ Through business clients.

___ Through Family.

___ Others (please specify) ____________________________________________________

HUMANITIES AND SOCIAL SCIENCES

 Republic of the Philippines
Department of Education
GONZAGA NATIONAL HIGH SCHOOL
Smart, Gonzaga, Cagayan

Please put () check mark on ways to maintain your relationship to your partner.

___ Understanding sexual needs.

___ Maintain secrecy in relationship.

___ Allows him/her to interact with another member of LGBTQ community.

___ Support his/her own interest.

___ Both family acceptance.

Part IV. Problems in LGBTQ Community

Please Enumerate your response if any on the below questions.

1. Problems or challenges before you revealed your sexual orientations.

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

2. Problems or challenges after you revealed your sexual orientations.

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

HUMANITIES AND SOCIAL SCIENCES