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Republic of the Philippines

Department of Education
National Capital Region

SURVEY QUESTIONNAIRE

Dear Respondent,

We are the Grade 10 students of (insert section here) and we are working on a research on the “insert
research title here”. May we request to kindly answer the questions in the survey questionnaire. Rest
assured that all information you provide will be confidential and will also enable our group to attain the
purpose of this study. Thank you for your cooperation.

The Researchers

Name (optional): _________________________________________ Age: _______________


Year Level: __________________ Section: ___________ Gender: ___________

I. Please answer the following questions. Put a check (√) mark on your answer.

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