Dear respondents,

We are the group 3 from the 4th year nursing students of Manila Adventist College
making a thesis research as part of our requirements. We are conducting a survey
regarding KNOWLEDGE, HEALTH BELIEF AND BREAST SELF EXAMINATION.
We are hoping you could spare us some of your precious time to complete this
survey form. Please read the questions carefully and answer them honestly. Your
cooperation would be very, much appreciated. Rest assured that the information
you will give would be kept confidential and will be used for academic purposes
only.
Thank you very much for your cooperation, God Bless!
Group 3
Adelino Pele,Delos Santos Markus, Delgado Annel, Hemedez Marie, Tendero Joy
Instruction: Check the appropriate box that corresponds to your answer
1. Demographic profile:
Religion:
Seventh - day Adventist Other (please specify)
Roman Catholic :________________
Iglesia
Born Again

Age: Year level:

15-16 1 st year
17-18 2 nd year
19-20 3 rd year
21-22 4 th year
23 and above