SURVEY QUESTIONNAIRE

Dear Respondents:
Greetings!
We are currently conducting research titled: “The Effect of Self Discipline and Tardiness on the
Perceived Academic Performance of Senior High School Students on DCLC”, a major requirement for our
Research in Daily Life 2 of the Senior High School Basic Education Department. In view hereof, we would like
to humbly seek assistance from you to conduct our research and be able to gather essential data and
information. Rest assured that the information/feedback to be provided will be treated with utmost
confidentiality as per Data Privacy Act 10173 of 2012 and will be utilized for academic research/study purposes
only.
For more inquiries or concerns, kindly contact Salvan, Fritz Adrian A., the research leader, through
email (fritzadriansalvan@lanting.ph.edu). Looking forward for your approval on our humble request.
Thank you.
Respectfully,
The Researchers

Part I. Demographic Profile

Direction: Fill in the following blanks.
Sex: _________ Grade Level: ________ Strand: _______
Part II. Self-Discipline
Direction: Please put a check (✓) in the box whether you strongly disagree (1), disagree (2), neutral (3), agree
(4), strongly agree (5) with the statements

1.) I get easily distracted. 1 2 3 4 5

2.) I refused to do things that are bad for me, even if they are fun.
3.) I’m good at resisting temptation.
4.) I always speak appropriately.
5.) I strive to always make the right choices.
Self-Control

1.) I should take responsibility for my actions.

2.) I should take care of my family.
3.) I should try to achieve my personal goals without harming others.
4.) I should be cooperative to other people.
5.) I should be a good member of society.
strongly disagree Neutral Strongly
Morality Agree
disagree agree

1.) I will always try to finish my work within class hours every day.
2.) I typically complete assignments with the given time frame.
3.) I constantly strive at school to achieve better results
4.) I prioritize taking breaks when they are needed for my well-being
and productivity.
strongly disagree Neutral Agree Strongly
5.) I always complete my personal duties. disagree agree
Work Ethics
Part III. Tardiness
Direction: Please put a check (✓) in the box next to the answer of your choice.
strongly disagree Neutral Agree Strongly
1.) I sleep early. disagree agree
2.) I do my assignment before going to bed.
3.) I use an alarm clock to wake up early.
4.) I go to school early.
5.) I have a healthy habit of avoiding phone usage before bed time.
Routine

1.) I make an effort now for future gains.

2.) I strive to achieve my goals.
3.) I like to study hard.
4.) I am interested learning new things.
strongly disagree Neutral Agree Strongly
5.) I am satisfied with my current achievement even though it is not disagree agree
better than others.
Motivation

1.) I need an alarm clock in order to wake up at the appropriate time.

2.) It is a struggle for me to get out of bed in the morning.
3.) I often fall asleep in boring class.
4.) I always tired, irritable and stressed-out.
5.) I often need a nap to get through the day.
strongly disagree Neutral Strongly
Sleep Deprivation Agree
agree
disagree

Part IV. Academic Performance

Direction: Please put a check (✓) in the box next to the answer of your choice.
strongly disagree Neutral Agree Strongly
1.) I made myself ready in all my subjects. disagree agree
2.) I pay attention and listen during every discussion.
3.) I want to get good grades in every subject.
4.) I actively participate in every discussion.
5.) I start assignments and projects as soon as they are given.
6.) I enjoy homework and activities because they help me improve my
skills in every subject.
7.) I exert more effort when I do difficult assignments.
8.) Solving problems is a useful hobby for me.
9.) I spend my vacant time doing assignments or studying my lessons.
10.) I study and prepared for quizzes and tests.
Thank You