Classroom Behavioral Problems Questionnaire

Part I. Personal Information

Direction:
Please read carefully each items and fill in the blank
or check appropriate blanks if needed.

Name: (Optional)________________________________
Year Taught:____________________________________
Section:________________________________________
School:_________________________Date:___________
Age:__________ Sex:__________
Length of Service_______________________________

Educational Attainment:
Major:___________________________________
Minor:_______________________
(_______) with M.A units (_______) with
Doctoral units
(_______) with Master’s Degree (_______) with
Doctoral units

Part II. Classroom Behavioral Problems of High School Role-

Model-Deprived Students

Direction:

Kindly go over each questions and check the column which

describes the degree of classroom behavioral problems of high

school role-model-deprived students towards their classmates,

towards their assignment and activities, and towards their

teachers. Base your answer on the following scale:

(3) High Degree -means the behavior is often

manifested
 (2) Moderate Degree -means the behavior is sometimes

manifested

(1) Low Degree -means the behavior is less

manifested

A. Classroom Behavioral Problems of High School Role-Model-

Deprived Students towards their Classmates (inferiority,
cheating, bullying, fighting)

As a teacher I observe the role- High Moderat Low

model-deprived students manifest Degre e Degree Degre
the following: e (2) e (1)
(3)
1. stay away from their classmates
2. copy assignment on their
classmates
3. share leakages with their
classmate
4. copy the answers on their
classmates
5. laugh at the wrong answers of
their classmates
6. make rude gestures on their
classmates
7. box/slap their classmates
8. throw pieces of papers and other
similar objects to their classmates

B. Classroom Behavioral Problems of High School Role-Model-

Deprived Students towards their Assignment and Activities
(dishonesty, shyness, truancy, tardiness, lack of interest).
As a teacher I observe the role- High Moderate Low
model-deprived students manifest Degree Degree Degree
the following: (3) (2) (1)
1. invent illnesses to cover up
unexcused absences
2. let others do their project in
school
3. unwilling to join classroom
discussion
4. escape classes
5. miss classes without valid
reasons
6. report to school late
7. could not attend flag ceremony
8. talk/chat with their classmates
while the teacher is discussing
the lesson

C. Classroom Behavioral Problems of High School Role-Model-

Deprived Students towards their Teachers (disobedience,
timidity, disrespectfulness, vandalism, dawdles of daily
routine).
As a teacher I observe the role- High Moderate Low
model-deprived students manifest Degree Degree Degree
the following: (3) (2) (1)
1. look away when being spoken to
2. refuse to obey the rules and
regulation
3. do not share their experiences
with their teachers
4. leave the class without
teacher’s permission
5. write on walls and chairs in
the classroom
6. destroy classroom facilities
and instructional materials
7. do not submit their assignments
on time
8. Waste time in doing their
cleaning assignment

Thank you very much for your time and cooperation…

Researcher