PERSONAL. Please fill up the blank provided.

Name: _______________________________ Name of School _____________________________

Sex: _____ Male _____ Female _____ Age: _____

EDUCATIONAL ATTAINMENT OF PARENT. Please check the space provided.

Father Mother

_____ Elementary Level _____

_____ Elementary Graduate _____

_____ High School Level _____

_____ High School Graduate _____

_____ College Level _____

_____ College Graduate _____

STUDY HABITS

1. How often do you study science?

_____ _____ _____ _____
Once a wee Twice a week Three Times a week Everyday
2. How long you have to study science?
_____ _____ _____ _____
3. Once a wee Twice a week Three Times a week Everyday

_____ _____ _____ _____

Once a wee Twice a week Three Times a week Everyday

4. I do my assignments alone every night.

_____ _____ _____ _____
Once a wee Twice a week Three Times a week Everyday

PARENTAL FOLLOW UP

1. My parents encourage me to study at home.

_____ _____ _____ _____
Always Most of the time Sometimes Never

2. My parents do not care about my studies.

_____ _____ _____ _____
Always Most of the time Sometimes Never
3. My parents asked me about the things I learned in School.
_____ _____ _____ _____
Always Most of the time Sometimes Never

4. My parents do not find time to talk about my schooling.

_____ _____ _____ _____
Always Most of the time Sometimes Never

5. My parents teach me when I am at home.

_____ _____ _____ _____
Always Most of the time Sometimes Never

6. My parents do not care receiving my report card.

_____ _____ _____ _____
Always Most of the time Sometimes Never

7. My parents help me make my assignment and project.

_____ _____ _____ _____
Always Most of the time Sometimes Never

8. My parents do not attend meeting in school.

_____ _____ _____ _____
Always Most of the time Sometimes Never

9. My parents asking me, “Do you ask question in the class?”

_____ _____ _____ _____
Always Most of the time Sometimes Never

10. My parents encourage me to go to school always.

_____ _____ _____ _____
Always Most of the time Sometimes Never