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Questionnaire

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3 views

Questionnaire

Uploaded by

tanedotrish
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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RESEARCH SURVEY-QUESTIONNAIRE

Name:

Grade and Section:

Age:

Sex:

General Direction:

Please be completely honest when answering the following questions.

Directions:

Check the box next to the item that corresponds to your response. Kindly indicate the

specifics.

1. How frequent do you eat breakfast?


 Always
 Often
 Sometimes
 Rarely
 Never

2. What do you usually eat for breakfast?


 I do not eat breakfast
 Only a cup of water
 Only a cup of coffee
 Only a cup of milk
 A cup of water and bread
 A cup of coffee and bread
 A cup of milk and bread
 A cup of water, rice, and viand
 A cup of coffee, rice, and viand
 A cup of milk, rice, and viand
 Others: (please specify)

Very
Excellent Good Bad Terrible
Good

3. How would you rate your


performance as a student if you did
not eat breakfast?

4. How would you rate your ability to


focus if you did not eat breakfast?

5. How would you rate your


performance as a student if you only
have a cup of beverage as your
breakfast?

6. How would you rate your ability to


focus if you only have a cup of
beverage as your breakfast?

7. How would you rate your


performance as a student if you only
have a cup of beverage and bread
as your breakfast?

8. How would you rate your ability to


focus if you only have a cup of
beverage as your breakfast?

9. How would you rate your


performance as a student when if
you have a cup of beverage, rice,
and viand as your breakfast?

10. How would you rate your ability to


focus if you have a cup of beverage,
rice, and viand as your breakfast?

11. How often do you skip breakfast?


 Always
 Often
 Sometimes
 Rarely
 Never

12. What are the factors that prevents you from eating breakfast? Check all that
applies.
 Diet
 Laziness
 Lack of Time
 Lack of Appetite
 Others: (please specify)

13. How often does an empty stomach in the morning classes has hindered your
academic performance?
 Always
 Often
 Sometimes
 Rarely
 Never

14. What are the effects of lack of breakfast to you that directly affects your
performance as a student?
 Grumbling stomach
 Lack of focus
 Laziness
 Stomachache
 Dizziness
 Others: (please specify)

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