Effects of Social Anxiousness on Academic Performance

of Grade 12 Students Questionnaire

Name (Optional): _____________________________________ Grade & Section: _________________

Sex: Male Female Age: ______ Grade Average (Optional): _______

Directions: For each item in the survey, indicate how much the student relate on the shown situation below by leaving a
check ( / ) on the right side of the statement. There are no right or wrong answers. Honesty on the response is highly
appreciated and would help the researchers a lot. Your answers will be kept strictly confidential and you will not be
identified.

Scale: 1 – Slightly (Indicates that the situation is seldom experienced)

2 – Moderate (Indicates that the situation is sometimes experienced)

3 – Very (Indicates that the situation is often experienced)

4 – Extremely (Indicates that the situation is always experienced)

Part I. Social Anxiety on Academic Performance

1 2 3 4
Student-to-Class Interactions Slightly Moderate Very Extremely

1. I feel an overwhelming fear

when you speak in front of the
class.
2. I worry about embarrassing or
humiliating yourself
accidentally in front of the
class.
3. I feel an intense fear of
interacting or talking to new
classmates.
4. I feel uncertainty and
discourage to participate on
recitations.
5. I am having a hard time letting
out the ideas you want to say
on group activities you have to
take part on.
6. I think being socially anxious
affects your academic
performance.
7. I feel anxious because there
may be a delay in the
education for students.
8. I feel anxious about teachers
not having enough time to
teach me.
9. I feel anxious that the
academic ability gap might
widen between students/ my
classmates.
 10. If I have to write on the
blackboard in front of other
people, I get nervous.
11. If I enter the classroom where
everyone are already seated, I
become self-conscious.
12. When my classmates are
watching me perform a
performance task, I am
concerned about my shaking
and trembling.

Part II. Socializing

1 2 3 4
First Meeting Slightly Moderate Very Extremely

1. I have a hard time making eye

contact with others.
2. I get nervous when I have to
speak with someone in
authority. (teacher, boss, etc.)
3. I am uncomfortable when it
comes to socializing.
4. I am concerned that I will not
know what to say in social
situations.
5. I am having a hard time
mixing/ getting along in a
group.
6. I am worried that people will
think my behavior is strange.
7. If I know people are watching
me, I feel awkward and tense.

Making Friends

8. I become tense when I have to

discuss myself or my
emotions.
9. I find it easy to make friends
my own age.
10. If I am alone with only one
person, I get tense.
11. I have difficulty conversing
with others.
12. I am concerned about
expressing myself in case I
come across as awkward.
13. I find it difficult to disagree
with someone else’s point of
view/ opinion.
14. I am afraid I will say something
embarrassing when talking.
15. When I am in a group, I am
worried about getting ignored.
16. I can become suddenly aware
of my own voice and the
presence of others who are
listening to me.
Have you been professionally diagnosed with Social Anxiety?

Yes
No
Prefer not to say

Even if you were NOT diagnosed with Social Anxiety, what is the chance that you have have/ had some
problems with Social Anxiety while in Senior High School?

A very good chance

Some chance
Very little chance
No chance at all

If you answered “A very good chance” or “Some chance” to the previous question, what is the chance
that Social Anxiety may have negatively affected your ability to perform at your very best in Senior High
School and earn higher grades?

A very good chance

Some chance
Very little chance
No chance at all

References:

Mayo Clinic (2021)

https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561?
fbclid=IwAR0aO0Te0PuTBkR--hcHVylD9_a5a-TegsxxadMziB2WXP4jAl_K3mljvbc

BioMed Central Ltd. (2022)

https://www.bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11130-y/tables/2?
fbclid=IwAR1Iig7tai1bwEj_2FWOlp4trPWmQgtDlTA8O7IanrfuUWXa6hpE3y4aGSA

Erin Tayag & Leea Gonzales (2021)

https://www.scholarworks.lib.csusb.edu/cgi/viewcontent.cgi?
article=2351&context=etd&fbclid=IwAR112Kef5mdltpQFn91OdSx7v_dHL5BtII_vro7PpsOxmBqL5jTAIbHV2dk