QUESTIONNAIRE

IMPACT OF SCHOOL BULLYING TOWARDS THE ACADEMIC ACHIEVEMENTS

AMONG PUBLIC HIGH SCHOOL STUDENTS IN ROXAS CITY AS EVALUATED BY

TEACHERS

To Respondents: This questionnaire is intended to gather data from

the impact of school bullying towards academic achievements among

public high school students in Roxas City during calendar year

2019.

I. SOCIO-DEMOGRAPHIC PROFILE

DIRECTION: Please kindly supply the needed data needed and

answer the questions as sincerely as you can. Please do not

leave any item unanswered.

Name: ______________________________________________(Optional)

Age: Civil Status:

20 – 25 years old Single

26 – 30 years old Married

31 - 35 years old Widow

35 and above years old

Sex:

Male

Female
High School:

Bago National High School

Balijuagan National High School

Cong. Ramon A. Arnaldo High School

Capiz National High School

Culasi National High School

Dumolog National High School

Milibili National High School

Tanque National High School

 II. STATEMENTS THAT DESCRIBES OVERT ACTS OF BULLYING INCIDENCES

AS EVALUATED BY TEACHERS

STATEMENTS ON PHYSICAL BULLYING 5 4 3 2 1

1. Stepping on other student’s feet.
2. Slapping the face of another student.
3. Punching a student
4. Kicking another student
5. Intentionally bumping another student while
passing.
6. Destroying others property
7. Pushing another student
8. Spitting on someone
9. Tripping or trying to make another student lose
balance.
10. Forced taking of another student’s possession

STATEMENTS ON PSYCHOLOGICAL BULLYING 5 4 3 2 1

1. Rude namecalling of another student
2. Cursing or use of offensive language towards
another student
3. Making mean or rude hand gestures to other
students
4. Body shaming or telling another student of being
ugly
5. Use of coercion and intimidation to follow
another student’s demands
6. Exclusion from group activities
7. Discriminatory acts because of gender, color of
skin, etc.
8. Spreading false rumors about a student’s
personal backgrounds
9. Making a scene in order to embarrass another
student
10. Public humiliation of another student by
certain malicious acts.
 III. STATEMENTS THAT ASSESS IMPACT OF SCHOOL BULLYING TO
ACADEMIC ACHIEVEMENTS AMONG PUBLIC HIGH SCHOOL STUDENTS AS
EVALUATED BY TEACHERS

STATEMENTS 5 4 3 2 1
1. Student showing signs of uneasiness (anxiety)
during class and often asks permission to go out.
2. Noticeable significant decrease in academic
performance in one or more subjects.
3. Student becomes elope or likes to be alone when
it is not the case before.
4. Less participative to any social activities e.g.
group reporting or sports activities in P.E.
subjects.
5. Decreased class participation and/or performance
for oral recitation or class discussion and
refusal to answer when told to answer.
6. Student exhibits gloomy or sullen behavior (being
silent, bitter or downcast e.g. does not often
talk) even when tasked to perform.
7. A student who develops low self-confidence and
self-esteem when previously he/she is regarded as
the/one of the leaders of the class.
8. Noticeable development of absenteeism or
prolonged absence from school pertaining to
medical reason (e.g. headache, toothache,
stomachache, etc.) when previously it is not
observed.
9. Students develop noticeable lack of concentration
to school works and activities; and expresses
poorer academic expression (e.g. poorer rating in
projects or papers submitted than usual)
10. Noticeable less enthusiasm in learning and
develops a habit skipping subjects.