Sample Questionnaire Essay Example for Free

Sample Questionnaire Essay The purpose of this survey is to determine to what extent the different factors in attitude do and study interest affects individual. Enclosed you will find a self-addressed, stamped envelope to use when returning the survey. Please feel free to include any additional comments you deem necessary or relevant to improving the behavioral aspect of individual. Be assured that all your answers are highly confidential and will be treated with privacy. Your response and time is greatly appreciated. Thank you! Sincerely, Floriden Dairo Camille Punzalan Marilyn Vargsa Mary Grace Romero John Paul Bernaldez (BSE III-B, English) Below is a list of statements. Please indicate how you feel about each statement by checking the box of your answer. How family background does affect your behavior and interest in study habits? 1. My parents really care for me (_) True(_) False 2. I get along well with my parents and siblings (_) True(_) False 3. My parents really listen to I have to say (_) True(_) False 4. My parents care whether I come at home very late at night (_) True(_) False 5. My parents didn’t pay attention to what I have to say. (_) True(_) False 6. My parents didn’t appreciate my effort (_) True(_) False 7. My parents always fight (_) True(_) False 8. My mother always nagged me especially if we do not have enough money (_) True(_) False 9. My parents didn’t support our studies (_) True(_) False 10. My parents encouraged me to have an occupation at an early age (_) True(_) False How do gadgets affect your attitude and interest in the study? Check your answers. 1. What gadgets do you have? (_)Cellular phone (_) IPod (_) Television (_) Radio (_) Digital Camera (_) others 2. Do you really want to play games, listen to music, etc. rather than studying your lesson? (_)Yes (_) No 3. Whenever your mother does the household chores, do you help her? (_)Yes (_) No 4. At night, do you prefer to listen in the radio, instead of taking a rest? (_) Yes (_) No 5. Instead of playing outdoor activities, do you prefer to stay at home and play with your gadgets? (_) Yes (_) No 6. Did your parents bought whatever you ask, like all your gadgets for you to be in with your armadas? (_)Yes (_) No 7. Did radio, television, and other technologies sometimes help you to do your school activities? (_) Yes (_) No 8. Do you use your gadgets to degrade your classmates for not having it? (_)Yes (_) No 9. Did you spend more time with your gadgets rather than with your family? (_)Yes (_) No 10. Did your parents allowed you to addict in all gadgets that may cause of losing your interest with your studies. (_)Yes (_) No How do peers and peer pressure affects your attitude and study interest? Do you prefer to do things independently? (_) Yes (_) No Do you prefer to do things with the help of your friends? (_) Yes (_) No Do your friends affect largely your decision-making? (_) Yes (_) No Do you always decide based on your peer’s decisions? (_) Yes (_) No Do you consider your friend’s judgments before making friends to others? (_) Yes (_) No I am conscious about what I will wear before my friends might tease me. (_) Yes (_) No Are you afraid on bullying? (_) Yes (_) No If yes, do you have a feeling that if you neglect your friend’s judgments, they might bully you? (_) Yes (_) No If no, do you believe that â€Å"if you don’t do something wrong, nothing should be shame of†? (_) Yes (_) No Do you agree that self-progression is through your own hard work and perseverance? (_) Yes (_) NO 1) How familiar are you with your schools mission statement for school safety Very Familiar Somewhat familiar Not too familiar Not at all Familiar 2) How familiar are you with your schools emergency response plan? Very Familiar Somewhat familiar Not too familiar Not at all Familiar Please tell us how much you agree or disagree with the following statements. 3) School staff and administration uphold all discipline policies. Strongly Disagree Disagree Undecided Agree Strongly Agree 4) The school provides adequate training for staff on school policies and procedures. Strongly Disagree Disagree Undecided Agree Strongly Agree 5) Emergency response plans are known by all teachers and administration. Strongly Disagree Disagree Undecided Agree Strongly Agree 6) Emergency response drills are performed regularly by teachers and students. Strongly Disagree Disagree Undecided Agree Strongly Agree 7) The school has an anonymous student hotline for reporting potential safety problems, such as threats. Strongly Disagree Disagree Undecided Agree Strongly Agree 8) The school takes all threats and rumors of violence seriously and investigates appropriately. Strongly Disagree Disagree Undecided Agree Strongly Agree 8) All visitors to the school are acknowledged and accounted for at all times. Strongly Disagree Disagree Undecided Agree Strongly Agree Please tell us how satisfied or dissatisfied you are with the following: 9) How satisfied are you with the level of control the school maintains on all entrances and exits? Very Satisfied Satisfied Dissatisfied Very Dissatisfied Dont Know 10) How satisfied are you with the exterior safety lighting? Very Satisfied Satisfied Dissatisfied Very Dissatisfied Dont Know 11) How satisfied are you with the interior safety lighting? Very Satisfied Satisfied Dissatisfied Very Dissatisfied Dont Know 12) How satisfied are you with the level of support the administration gives to teachers for dealing with discipline problems? Very Satisfied Satisfied Dissatisfied Very Dissatisfied Dont Know 13) Overall, how safe do you feel in your classroom? Very Safe Some what safe Not too safe Not at all Safe Dont Know 14) Overall, how safe do you feel outside on the school grounds? Very Safe Some what safe Not too safe Not at all Safe Dont Know 15) Overall, how satisfied are you with your schools safety policies? Very Satisfied Satisfied Dissatisfied Very Dissatisfied Dont Know 16) Overall, how satisfied are you with your schools emergency response plan? Very Satisfied Satisfied Dissatisfied Very Dissatisfied Dont Know Please indicate the extent to which the following are problems for you. Always-3 Often 2 Sometimes -1 Never 0 Cutting classes Saying bad words Bullied Smoking Financial problem Absenteeism Excessive use of alcohol Sleeping during the class Late homework Latecomer Cheating Fighting with others students Using cell phones/iPods/electronics during class hour Being honest about all rules Please indicate the extent to which the following are the appropriate assessment for the behavioral development of the students. Strongly Agree-3 Agree-2 Disagree-1 strongly disagree-0 Conducting seminars and Programs Making organizations having counseling Punishments Dismissal of the students from school Detention References Durand, V. M., Crimmins, D. B. (1992). Motivation assessment scale. Topeka, KS: Monaco Associates Incorporated. Iwata, B. A., DeLeon, I. G. (1995). The functional analysis screening tool (FAST). Unpublished manuscript, University of Florida. Lewis, T.J., Scott, T., Sugai, G. (1994). The problem behavior questionnaire: A teacher-based instrument to develop functional hypotheses of problem behavior in general education classrooms. Diagnostique, 19(2-3), 103-115. Mason, S. A. Egel, A. L. (1995). What does Amy like? Using a mini-reinforcer assessment to increase student participation in instructional activities. Teaching Exceptional Children, 28, 42-45. O’Neill, R. E., Horner, R. H., Albin, R. W., Storey, K., Sprague, J. R. (1997). Functional assessment and program development: A practical handbook. Pacific Grove, CA: Brookes/Cole Publishing Company. Singh, N. N., Matson, J. L., Lancioni, G. E., Singh, A. N., Adkins, A. D., McKeegan, G. F., Brown, S. W. (2006). Questions about behavioral function in mental illness (QABF-MI). Behavior Modification, 30(6), 739-751. https://www.google.com.ph/search?q=sample+survey+questionnaire+about+family+backgroundtbm=ischtbo=usource=univsa=Xei=BWpdUp62E8fxiAfUiIGIDwved=0CGIQsAQbiw=1366bih=664#facrc=_imgdii=_imgrc=bWprTi6c_vvXQM%3A%3B9lwusfzU6z3OBM%3Bhttp%253A%252F%252Fwww.uncssp.org%252Fimages%252Fsspsamplequestions_school11ak.gif%3Bhttp%253A%252F%252Fwww.uncssp.org%252Fabout_samplequestions.asp%3B300%3B392 Questionnaire (SOCS II) Submitted by: Camille Punzalan Floriden Dairo Marilyn Vargas Mary Grace Romero John Paul Bernaldez Submitted to: Ms. Mileth Caraan (SOCS 2 Teacher) GOODBYE By; Anonymous I wish I hadn’t met someone like you Someone who is good to be true Someone  with charms of dreams, of fiction Someone you’d be willing to pour out your affection Goodbye for me, I won’t look back Your jokes so funny, you’d make me crack Your laughter, your smile, voice so sweet Your lips so red, your eyes so deep. To my questions you are the answer You are the bonfire in the cold day of winter You are the rain that makes flower bloom You are the light that comes from the moon. But goodbye for now, we must part You’ll always occupy a place in my heart As I turn my back, forget and be glad Rather than remember and be sad Just wipe your eyes and smile once more Hope you’d find what you’re looking for Goodbye my life, my strength, my love, A gift of fate from heavens above.