SAMPLE QUESTIONNAIRE

Name (Optional): ___________________________________ Age: _____________

Grade & Section: _______________________ Gender: ___________

General Instruction: Please read each question carefully and encircle your selected response. Choose
what best reflects your thoughts, feelings, or experiences. There are no right or wrong answers, and your
responses will be kept confidential and anonymous. Thank you for your participation and contribution to
this research project. Your input is greatly appreciated.

1. How often do you experience feelings of anxiety or nervousness when studying for exams or
completing assignments?

a. Almost never

b. Rarely

c. Sometimes

d. Often

e. Almost always

2. What specific aspects of studying cause you the most anxiety (e.g., test-taking, time management,
workload, etc.)?

a. Test-taking

b. Time management

c. Workload

d. Other (please specify): ___________

3. How do you typically cope with study-related anxiety (e.g., deep breathing, taking breaks, seeking
support from others, etc.)?

a. Deep breathing exercises

b. Taking breaks

c. Seeking support from friends or family

d. Seeking support from teachers or counselors

e. Other (please specify): ___________

4. Have you ever sought help for study-related anxiety from a teacher, counselor, or other professional?
If so, please describe your experience.

a. Yes

b. No