Polanco National High School

Senior High School

Empowerment Technologies

Survey Form

Name: __________________________________________________ Age: _________

Income/day: _______________________________________________ (optional)

Instructions: Circle the letter of your answer.

1) On a scale of 1-5, how would you rate the product’s quality?

a. 1 b. 2 c. 3 d. 4 e. 5

2) On a scale of 1-5, how would you rate the product’s taste?

a. 1 b. 2 c. 3 d. 4 e. 5

3) On a scale of 1-5, how would you rate the product’s presentation?

a. 1 b. 2 c. 3 d. 4 e. 5

4) Are you satisfied with the product?

a. Yes b. No

5) Would you recommend the product to a friend?

a. Yes b. No

6) How much are you willing to pay for this product?

a. Php4 and below
b. Php5-10
c. Php11-15
d. Php16-20
e. Php21-25

Suggestions or comments:

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