SURVEY QUESTIONNAIRE

Dear Respondent,
We are doing a study on Cases of Bullying among USLS Engineering Students. In this
regard, may we ask for your precious time to answer this survey form? Your honest response will
be treated with utmost confidentiality.
Thank you very much.
Truly yours,
Fritz Villareal
Giancarlo Toledo
Raulph Christian Uy Sarona
Ronnell John Jonota
Name: ____________________________________________ Course/Year/Section: ________________
Sex: ______
Directions: Check the items corresponding to your answers. Please give other details when
needed.
1. Are you aware of what Bullying is?
_____ YES
_____NO
If so, what do you think are the different types of bullying? (Check all that
apply)
_____ Physical (e.g., beating)
_____ Emotional/Mental (e.g., backbiting,
being an outcast)
_____ Cyber (e.g., Internet/Social Media, Etc.) _____ Prejudicial/Racial (e.g., Racism)
_____ Sexual (e.g., unwanted sexual gestures)
_____ others (Please Specify:
___________________________)
2. Have you experienced Bullying?
_____ YES
_____ NO
If so, what type of Bullying did you experience? (Check all that apply)
_____ Physical
_____ Emotional/Mental
_____ Cyber
_____ Prejudicial/Racial
_____ Sexual
_____ others (Please Specify:
___________________________)
3. What do you think are the causes
_____ Depression
_____ Academic/School Problems
_____Decrease of Self-Esteem
_____ Injuries
_____Breakdown
___________________________)

of Bullying? (Check all that apply)

_____ Nervousness
_____ Suicidal Thoughts
_____ Anger/Rage
_____ Mental Change
_____ others (Please Specify:

4. What do you think is/are the factor/s of bullying? (Check all that apply)
_____ Family/Home
_____ Peer
_____ Other Bullies
_____ Mental State
_____ Neglection
_____ others (Please Specify:
___________________________)
5. On a scale of 1 5 (1 as the lowest and 5 as the highest), rank the given aspects
according to the gravity of effect of Bullying.
_____ Physical
_____ Mental

_____ Emotional
___________________________)
_____ Academical

_____ others (Please Specify: