Media Impact on Academic Performance Survey
Age Group
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Option 1
Option 2
Option 3
Average Daily Media Usage (hours)
*
Please Select
Option 1
Option 2
Option 3
Type of Media Most Used
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Option 1
Option 2
Option 3
Do you feel media usage affects your academic performance?
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Option 1
Option 2
Option 3
Please explain how media usage impacts your academic performance.
Rate your overall academic performance
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1
2
3
4
5
Submit
Should be Empty: