Immaculate Conception School of Guiuan, Inc.

Brgy.9-A, Guimbaolibot Avenue

Guiuan, Eastern Samar

SURVEY QUESTIONNAIRE ON FACTORS AFFECTING THE ACADEMIC

ACHIEVEMENT OF SENIOR HIGH SCHOOL STUDENTS IN THE
DISTANCE LEARNING IN IMMACULATE CONCEPTION SCHOOL OF
GUIUAN, INC.

Name (optional): ________________________________________________

Source: Olufemi et al. (2018)
Part I. Profile of the Respondents
Directions: Put a check on the item you belong.
Sex:
____ Male
____ Female
Age:
____ 15-16-year-old
____ 17-18-year-old
____ 19- 20-year-old
____ 21 and above
Specialization
____ HUMSS
____ TVL-CSS
____ TVL- HE
Part II. Factors Affecting the Academic Achievement of the Respondents
Directions: Please put a check (√) and rate yourself honestly based on what
you actually do given the statements using the following scales:
5 – Strongly Agree 4 – Agree 3 – Neutral 2 – Disagree 1 – Strongly Disagree

A. Students Learning Skills 5 4 3 2 1

1. I don’t have a study habits for my learning
activities.
2. I have trouble relating background
knowledge in reading.
3. I can’t learn a new lesson without someone
guiding me.
4. I’m having a hard time understanding a
particular subject.
5. I find it hard to understand English
language.
 Immaculate Conception School of Guiuan, Inc.
Brgy.9-A, Guimbaolibot Avenue
Guiuan, Eastern Samar

6. Among all the students learning skill,

analyzation is what I am bad at.
7. It is hard to do self-study.
8. I can’t use the universal language correctly.
9. I can’t speak and fully understand some of
the words of the universal language
properly.
10. I’m better in oral communication than
written communication.
11. I’m bad at critical thinking.
12. I have a poor innovation skill.
13. I have trouble reading effectively.
14. I am bad at summarizing a particular topic,
15. I have trouble in constructing a sentence in
a correct grammar.

B. Students Negligence 5 4 3 2 1
1. I have a part time job which lessen my time
to study.
2. I don’t answer my module.
3. I often use my phone than learning and
answering my activities.
4. I prefer hanging out with friends.
5. I purposely don’t submit my requirements
on time.
6. I am unmotivated in studying.
7. I don’t like the idea of this new normal
educational system. (Modular Distance
Learning)
8. I don’t care if I don’t pass one of the
subjects.
9. I spend more time using Facebook than
answering my learning activity sheets.
10. I rely a lot on my classmate’s answer.
11. I spend more time playing video games
than answering my learning activity sheets.
12. I prefer sleeping than doing my school
works.
13. I am more motivated on earning an income
than studying.
14. I am giving in to procrastination.
15. I tend to answer the activity immediately
without reading the learning material.
C. Development of Learning Module 5 4 3 2 1
1. The structure of the learning module is not
well organized.
2. It has overloaded lesson activities.
3. The learning modules have only limited
 Immaculate Conception School of Guiuan, Inc.
Brgy.9-A, Guimbaolibot Avenue
Guiuan, Eastern Samar

information.
4. The statements or the words in the learning
modules are so deep which is hard to
understand.
5. Some activities are not connected to the
lesson.
6. It doesn’t have clear instructions.
7. It has a very long reading material.
8. It has a lot of word errors which is confusing
to understand.
9. The activities have lots of deep words which
is hard to comprehend,
10. It includes things that are not that
important.
11. The activities are too much for me to
answer.
12. It uses a lot of unfamiliar words which
makes it harder to understand the learning
module.
13. The examples given are not that sufficient.
14. The picture examples shown in every
lesson are not clearly seen.
15. The time period for the submission of the
modules are short, knowing that it has
longer reading materials and too much
activities.

D. Students Environment 5 4 3 2 1
1. There is no proper place to study at home.
2. I live in a noisy street.
3. My neighbor always plays loud music which
distracts me from studying.
4. I cannot entirely have a full focus in
studying since we still have responsibilities
at home.
5. I can’t concentrate in studying because my
family members order me around.
6. I have a little sibling which keeps on inviting
me to play to play with him/her which
distracts me from studying.
7. The lessons I’m studying can’t get into my
head because I have a newly born sibling
which cries a lot.
8. I can’t study well when my friend’s in our
neighbourhood keeps inviting me to play
sports and some other stuffs.
9. I live near the market where there are loud
voices by people and sounds of vehicles
which is really distracting.
 Immaculate Conception School of Guiuan, Inc.
Brgy.9-A, Guimbaolibot Avenue
Guiuan, Eastern Samar

10. There is no quite place in our house to

stay to study.
11. Small noises can make the idea that was
constructed in my head be gone just after
hearing the noise.
12. I have pets on the house which sometimes
tear apart my learning modules.
13. I cannot concentrate answering my
activities when I’m at home together with
my family members.
14. I sometimes forgot to answer my learning
activity sheet because I’m at home only I
got busy with various things in the house.
15. I can’t still adapt the fact that we’re self-
studying at our own houses.

E. Financial Problem 5 4 3 2 1
1. My parents pay my school bills late because
it went to other paying bills that’s why I
received my module late and I cannot
submit it on time.
2. My family can’t support my finances at
school.
3. The school’s expenses are too expensive.
4. I can’t afford to buy materials needed in my
day to day modular distance learning.
5. My parents struggle a lot in paying other
finances in our school.
6. My parents do not have a permanent job to
sustain the family needs and my school
needs.
7. My parents can’t pay immediately the
schools monthly fee.
8. My parents aren’t able to give me my daily
needs in taking my school works.
9. I know that we don’t have enough money to
pay for the bills and school finances
10. My parent’s salary from their job is not
enough to sustain us with our school needs.
11. My parents can’t sometimes buy food for a
meal, which affects my health condition,
then affects my focus on studying.
12. My parents can’t buy us our basic needs
and wants which causes my study to be
affected.
13. I cannot afford what my schoolmates
have.
14. I can’t afford to buy important things
needed for my school works.
15. Having money crisis makes me want to
 Immaculate Conception School of Guiuan, Inc.
Brgy.9-A, Guimbaolibot Avenue
Guiuan, Eastern Samar

work on a particular job to earn money than

to go to school.

Part III. Academic Achievement

First Semester Semester Final
Subjects
1 Quarter
st
2nd Quarter Grade
Komunikasyon at Pananaliksik
sa Wika at Kulturang Filipino
21st Century Literature from
the Philippines and the World
General Mathematics
Earth and Life Sciences
Personal Development
P.E. and Health
Oral Communication Context
Empowerment Technology
Introduction to World Religions
and Beliefs Systems
General Average
For Grade 11 - HUMSS

For Grade 12 - HUMSS

First Semester Semester Final
Subjects
1st Quarter 2nd Quarter Grade
Introduction to Philosophy of
the Human Person
Understanding Culture,
Society and Politics
Physical Education and Health
English for Academic and
Professional Purpose
Practical Research 2
Filipino sa Piling Larangan
Disciplines and Ideas in the
Applied Sciences
Creative Nonfiction
Philippine Politics and
Governance
General Average

For Grade 11 – TVL

First Semester Semester Final
Subjects
1 Quarter
st
2nd Quarter Grade
Komunikasyon at Pananaliksik
sa Wika at Kulturang Filipino
21st Century Literature from
 Immaculate Conception School of Guiuan, Inc.
Brgy.9-A, Guimbaolibot Avenue
Guiuan, Eastern Samar

the Philippines and the World

General Mathematics
CSS/Cookery
Personal Development
P.E. and Health
Oral Communication Context
Empowerment Technology
General Average

For Grade 12 - TVL

First Semester Semester Final
Subjects
1 Quarter
st
2nd Quarter Grade
Introduction to Philosophy of
the Human Person
Understanding Culture,
Society and Politics
Physical Education and Health
English for Academic and
Professional Purpose
Practical Research 2
Filipino sa Piling Larangan
CSS/FBS
General Average