SURVEY QUESTIONNAIRE
(Home Economics Students)
I. Respondent’s Profile
Sex: □ Male □ Female
Grade Level: □ 11
□ 12
II. BEHAVIOR SELF AWARENESS AND LIFESTYLE OF HOME ECONOMICS STUDENTS
Direction: Please check () your answer to the following questions using the scales below.
Rating Scale Descriptors Meaning
5 Always The statement is true some all the time.
4 Frequently The statement is true to me most of the time.
3 Occasionally The statement is quite true to me.
2 Rarely The statement is not often true to me.
1 Never The statement is not true to me at all.
I. BEHAVIOR SELF AWARENESS
A. ASSERTIVE 5 4 3 2 1
As a student, I…
1. appreciate people’s views, even if they differ from mine.
2. listen to people if they find approachable and easy to talk to.
3. ask for help easily without feeling anxious or uncomfortable.
4. can express my feelings and opinions constructively and
calmly to attend.
5. take time to think about my responses to their
consequences.
B. AGGRESSIVE
As a student, I…
1. am rude if others are rude to me.
2. am comfortable letting go of my work and tasks.
3. disagree with someone and resist or oppose change no
matter what
4. consider myself hot-headed and little things easily angers
me.
5.am lively with people.
C.PASSIVE
As a student, I…
1. will do all I can do to avoid confrontation by trying to keep
the peace.
2. hate holding eye contact.
3. work hard to meet people’s needs, usually at my own
expense.
4. say ‘yes’ when asked to do something in case I upset them.
5. feel intimidated in presence of authority.
II. LIFESTYLE OF HOME ECONOMICS STUDENTS
A. Health Habits 5 4 3 2 1
As a student, I…
1. do not smoke.
2. do not eat food with preservatives.
3. sleep early to reenergize my body.
4. avoid drinking alcohol/liquor.
5. exercise regularly to keep me fit and healthy.
B. Physical Fitness
As a student, I…
1. exercise daily.
2. walk rather than commute when the distance is short.
3. avoid stressful activities.
4. join yoga exercise and other meditational activities.
C. Personal Responsibility
As a student, I…
1. avoid eating junk foods.
2. take advice from my doctor to keep myself fit and healthy.
3. avoid polluted places.
4. take care of my health.
5. avoid people with negative outlooks in life.
D. Nutrition and Stress Management
As a student, I…
1. avoid going out late at night.
2. take enough rest after stressful activities.
3. only eat healthy foods.
4. drink 8 glasses of water every day.
5. avoid stressful activities.