“UPSHOTS OF SLEEP DEPRIVATION DUE TO EARLY CLASS-HOUR SYSTEM

TO GRADE 11 ACLC STUDENTS OF ORMOC CITY”

This survey questionnaire was taken from the study, “Sleep Deprivation may Cause a Student
Immense Limitation and Frustration” by Jared Axelrod, Alex Goebel, and Ryan Jaskiel

Sleep Deprivation Survey

Thank-you for taking our survey on sleep deprivation. We plan to compile the results
you give us with other answers from around the school. If you cannot focus on the questions
long enough to answer, you may sleep deprived, and we need your results. Kindly encircle your
answer.
1. What grade are you currently in?

Freshman Sophomore Junior Senior

2. Approximately, how many hours of sleep do you receive per night?

<4 4 5 7 8 9 10 >10
3. What is your G.P.A. in first semester?

98-100 95-97 90-94 80-89 <80

4. On scale 1-10 how do you feel during the school day? (1 being worst)

1 2 3 4 5 6 7 8 9 10
5. How many sports do you play?

0 1 2 3 4 5 >6
6. Rank your performance in your sports from 1-10?

1 2 3 4 5 6 7 8 9 10 None
7. Have you ever fallen asleep in class before?

Yes No
8. Do you feel tired throughout the day?

Yes No
9. Do you think that if school started later you would get more hours of sleep?

Yes No
10. Which is most affected by your lack of sleep?

Academics Athletics Behavior Motivation I do not have a lack of sleep