TITLE:

I. DEMOGRAPHIC PROFILE:

NAME: (OPTIONAL)

AGE:

GENDER ASSIGNED AT BIRTH: (Male)_____ (Female)______

LAST PROGRAM ENROLLED:

LAST SCHOOL YEAR ENROLLED:

LAST YEAR LEVEL ENROLLED:

CONSENT

You are invited to participate in this research study

entitled:________________________________________________________. The purpose of this study
is to____________________________________________________________. Your participation in this
study is entirely voluntary. There are no risks associated with participation in this study and be assured
that your identity and information will be kept confidential.

Your withdrawal in this study is entirely voluntary and you have the right to withdraw at any time
without penalty.

By signing this form, you acknowledge that you have read and understood the information provided and
voluntarily agree to participate in this study.

Participant’s Name: (Optional)

Signature:

Date:

Contact Information:

If you have any questions, concerns, or would like further information about the study, please feel free to
contact___________________at email address:______________________.
II. INSTRUCTION.

Please check the box for your appropriate answer.

A. FINANCIAL CONSTAINT 1 2 3 4 5
1. I often face financial challenges every time
examination week comes.
2. My financial limitations play a significant role in how I
make decisions about my pursued educational program.
3. Financial constraints can make it difficult for me to
afford the required textbooks and study materials.
4. I sense that I am restricted in pursuing this career path
due to my financial situation.
5. I find it difficult to maintain my academic performance
while managing my finances.
6. My lack of finances impact my ability to participate in
extracurricular activities of campus events.
7. I feel that financial aid programs and scholarships will
help alleviate my financial burden.
8. I can pay my tuition dues on time.
9. I have the freedom to eat as much as I desire when I
am in school.
10.
B. MOTIVATION
1. I am motivated to achieve my academic goals and
aspirations.
2. I am driven to expand my knowledge.
3. I always feel motivated to come to school every day.
4. I am enthusiastic about meeting my classmates and
teacher everyday.
5. I always participate actively in class discussions and
activities.
6.
7.
8.
9.
10.
C. LEARNING CAPABILITY
1.
2.
3.
4.
5.
6.
7.
 8.
9.
10.
D. QUALITY OF TEACHING
1. The instructor provides students with a learning
activity most of the time.
2. The instructor communicate course material and
concepts effectively.
3. The instructor demonstrates a deep understanding of
the subject matter.
4. The instructor presents concepts and ideas in a way
that is easy to understand by giving clear explanations
and relevant examples.
5. The instructor actively encourage students to
participate and engage in class discussions.
6. The instructor shows genuine enthusiasm and passion
for the subject, making the class engaging and exciting.
7. The instructor gives feedback on assignments and
assessments promptly and offers helpful and
constructive comments.
8. The instructor fosters a positive and supportive
atmosphere in the classroom, making it conducive to
learning and growth.
9. The instructor motivates students to think critically
and develop problem-solving abilities.
10. The instructor incorporates instructional technology
and multimedia tools into the teaching process.
E. TIME MANAGEMENT
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Scale:

1 - Strongly Disagree

2 – Disagree

3 - Neutral

4 – Agree
5 – Strongly Agree