REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF EDUCATION
DIVISION OF PARAÑAQUE CITY
SUN VALLEY NATIONAL HIGH SCHOOL
Elizabeth Ave., Sta. Ana Drive, Sun Valley, Parañaque City

SURVEY QUESTIONNAIRE

“CAUSES AND EFFECTS OF MALNUTRITION IN THE ACADEMIC

PERFORMANCE OF THE SUN VALLEY NATIONAL HIGH SCHOOL
STUDENTS”

PART 1: PROFILE OF THE RESPONDENTS

INSTRUCTIONS: KINDLY FILL IN THE BLANK AND CHECK
THE BOX THAT CORRESPONDS TO YOUR ANSWER IN EACH OF THE
FOLLOWING QUESTIONS.

1.Name: ___________________________________________(optional)

Grade: ________Section:_________

2.What is your sex? Male Female

3.How old are you?

13-14 yrs. old 15-16 yrs. old 17-18 yrs. Old
4. How many are you in the family?
2-3 4-5 6-7
8-9 Others, please specify ___________
5. What are the occupation of your parents?
Housewife/ House husband Storekeeper/ Vendor
Driver Others, please specify ___________
6. What is your birth order?
Only Child Eldest Middle
Youngest Others, please specify __________
7. Where do you live?
Sapang Maligaya Cul de Sac
Sta. Ana Marcelo Green
Countryside Others, please specify _________
Lions Park

PART 2: PERCEPTION OF STUDENTS TOWARDS MALNUTRITION

INSTRUCTIONS: BELOW ARE STATEMENTS WHICH BEST
DESCRIBED THE STATUS OF YOUR PERCEPTION TOWARDS
MALNUTRITION ON ACADEMIC PERFORMANCE.
PLEASE CHECK THE NUMBER SCALE ACCORDINGLY.
5- STRONGLY AGREE
4- AGREE
3- NEITHER AGREE NOR DISAGREE
2-DISAGREE
1-STRONGLY DISAGREE

STATEMENTS SCALE

5 4 3 2 1

1. Malnutrition is only for the underweight or thin in { } { } { } { } { }

appearance.

2. Malnutrition is both for the underweight and { } { } { } { } { }

overweight.

3. Lack of financial support is why I got { } { } { } { } { }

malnourished.
PART 3: CAUSES AND EFFECTS OF MALNUTRITION TOWARDS
ACADEMIC PERFORMANCE
INSTRUCTION: BELOW ARE STATEMENTS WHICH BEST DESCRIBED
THE CAUSES AND EFFECTS OF MALNUTRITION TO THE ACADEMIC
PERFORMANCE. PLEASE CHECK THE NUMBER SCALE ACCORDINGLY.

5-STRONGLY AGREE
4- AGREE
3- NEITHER AGREE NOR DISAGREE
2- DISAGREE
1-STRONGLY DISAGREE

STATEMENTS SCALE

5 4 3 2 1
CAUSES
1. Having a big family limits our food intake. { } { } { } { } { }

2. I have parents who earn minimum wage or have no { } { } { } { } { }

job.

3. Lack of financial support why I got malnourished. { } { } { } { } { }

4. Inadequate food supply makes you retarded. { } { } { } { } { }

EFFECTS
5. Starving interferes my concentration on our class { } { } { } { } { }
discussions.

6. Experienced difficulty in memorizing and { } { } { } { } { }

understanding the important lesson in class.

7. Experienced a feeling of tiredness when in the { } { } { } { } { }

middle of class discussion.

8. Experienced a hard time on participating in class { } { } { } { } { }

due to starvation.

9. Having a tardiness in class. { } { } { } { } { }