ENGLISH FOR ACADEMIC AND

PROFESSIONAL PURPOSES
Quarter 2 – Module 3 :
Survey Questionnaire
ENGLISH FOR ACADEMIC AND PROFESSIONAL PURPOSES – SENIOR HIGH
SCHOOL
Alternative Delivery Mode
Quarter 2 – Module 3: Survey Questionnaire

First Edition, 2020

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Every effort has been exerted to locate and seek permission to use these materials from their
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over them.

Published by the Tagbilaran City Division

Schools Division Superintendent: Joseph Irwin A. Lagura
Asst. Schools Division Superintendent: Marcelo K. Palispis

Development Team of the Module

Writers: ANNA FAITH P. BAG-AO

GAIL ANN D. TINAMPAY
ANGELICA LAMBUS
CAMILLE JOY C. CAINGLET
CHERISH MAE L. OCON
Editors: MARGELYN M. CAÑON
Reviewers: AIMEE T. AMISTOSO
Illustrator: NONE
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Management Team: CID Chief: John Ariel A. Lagura, PhD
Division EPS in Charge of LRMS: Neolita S. Sarabia, EdD
Division ADM Coordinator

Printed in the Philippines by ________________________

Department of Education – Region VII- Tagbilaran City Division

Office Address: _Rajah Sikatuna Avenue, Dampas, Tagbilaran City__

Telefax: _(038) 544- 2147; 427- 1702________________
E-mail Address: _tagbilarancitydivision@yahoo.com_______________
ENGLISH FOR ACADEMIC
AND PROFESSIONAL
PURPOSES
Quarter 2 – Module 3 :
Survey Questionnaire
Introductory Message
For the facilitator:

Welcome to the ENGLISH FOR ACADEMIC AND PROFESSIONAL PURPOSES-

SENIOR HIGH SCHOOL Alternative Delivery Mode (ADM) Module on Survey
Questionnaire.

This module was collaboratively designed, developed and reviewed by educators both
from public and private institutions to assist you, the teacher or facilitator in helping the
learners meet the standards set by the K to 12 Curriculum while overcoming their personal,
social, and economic constraints in schooling.

This learning resource hopes to engage the learners into guided and independent
learning activities at their own pace and time. Furthermore, this also aims to help learners
acquire the needed 21st century skills while taking into consideration their needs and
circumstances.

In addition to the material in the main text, you will also see this box in the body of the
module:

Notes to the Teacher

As a facilitator you are expected to orient the learners on how to use this module. You
also need to keep track of the learners' progress while allowing them to manage their own
learning. Furthermore, you are expected to encourage and assist the learners as they do the
tasks included in the module.

For the learner:

Welcome to the English for Academic and Professional Purposes –Senior High
School Alternative Delivery Mode (ADM)Module on Survey Questionnaire.

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This module has the following parts and corresponding icons:

What I Need to Know This will give you an idea of the skills or
competencies you are expected to learn in the
module.

What I Know This part includes an activity that aims to check

what you already know about the lesson to take.
If you get all the answers correct (100%), you
may decide to skip this module.

What’s In This is a brief drill or review to help you link the

current lesson with the previous one.

What’s New In this portion, the new lesson will be introduced

to you in various ways such as a story, a song, a
poem, a problem opener, an activity or a
situation.

What is It This section provides a brief discussion of the

lesson. This aims to help you discover and
understand new concepts and skills.

What’s More This comprises activities for independent

practice to solidify your understanding and skills
of the topic. You may check the answers to the
exercises using the Answer Key at the end of the
module.

What I Have Learned This includes questions or blank

sentence/paragraph to be filled in to process
what you learned from the lesson.

What I Can Do This section provides an activity which will help

you transfer your new knowledge or skill into real
life situations or concerns.

Assessment This is a task which aims to evaluate your level

of mastery in achieving the learning competency.
Additional Activities
In this portion, another activity will be given to you
to enrich your knowledge or skill of the lesson
learned. This also tends retention of learned
concepts.

Answer Key This contains answers to all activities in the

module.

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At the end of this module you will also find:

References This is a list of all sources used in developing this module.

Jessie S. Barrot and Philippe John F. Sipacio, English for Academic and
Professional Purposes for Senior High School Quezon City: C & E
Publishing, 2016.

Sarah Mae Sincero, “Questionnaire Example”, Explorable, accessed

July 7, 2020, https://explorable.com/questionnaire-example

The following are some reminders in using this module:

1. Use the module with care. Do not put unnecessary mark/s on any part of the module.
Use a separate sheet of paper in answering the exercises.
2. Don’t forget to answer What I Know before moving on to the other activities included
in the module.
3. Read the instruction carefully before doing each task.
4. Observe honesty and integrity in doing the tasks and checking your answers.
5. Finish the task at hand before proceeding to the next.
6. Return this module to your teacher/facilitator once you are through with it.
If you encounter any difficulty in answering the tasks in this module, do not hesitate to
consult your teacher or facilitator. Always bear in mind that you are not alone.

We hope that through this material, you will experience meaningful learning and gain
deep understanding of the relevant competencies. You can do it!

What I Need to Know

This module will serve as a guide in designing, testing and revising survey
questionnaire. This will serve as aid in learning new knowledge on the structure and parts of
a questionnaire and develop skills in creating a good questionnaire as a tool in gathering
research data.

This contains the objectives, the learning competency, pre-test activities, discussion,
and exercises for mastery of learning and skills. It is expected to be accomplished in one
week.

After going through this module, you are expected to:

1. Define a survey questionnaire;
2. Determine the parts of a survey questionnaire;
3. Identify the guidelines in writing a survey questionnaire; and

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 4. Create an effective survey questionnaire.

What I Know
Directions: Read the question in each item carefully. Select the letter of the correct answer
from the given choices.
1. It is a formal piece of writing based on research.
a. survey report c. interview
b. technical report d. research paper
2. Below are the main structure of a survey report except one, which is NOT?
a. Introduction c. Conclusion
b. Main body d. Recommendation
3. It is a research instrument that consists of a set of questions or other types of prompts
that aims to collect information from a respondent.
a. survey questionnaire c. interview
b. academic report d. position paper
4. It is a part of the survey questionnaire that includes the name (optional), age, date of birth,
address, educational background and other personal information about the respondent.
a. personal information section c. main question section
b. basic questions section d. open-ended section
5. The following are the guidelines in preparing a survey questionnaire EXCEPT:
a. Ensure confidentiality of information
b. Make the respondent anonymous, if necessary.
c. Make biased and leading questions.
d. Give the respondents a sufficient time to answer the questionnaire.

What’s In

Determine what type of report is applicable for the following situations.

1. Convince the members of a community that they should start segregating wastes.
2. Find out where the fund of your school organization went.
3. Suggest a speaker for your graduation to the principal.
4. Endorse an applicant to your boss.
5. Show what to do in case of a dengue outbreak in your community.

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 What’s New
Read and answer honestly the sample personal survey and answer the questions that
follow.
Everyone has different goals in life. Please study the list carefully and then rate
each item in terms of how important. It is or you in your daily life on the scale
indicated.
Indicators Extremely Important Not Sure Unimportant Extremely
Important Unimportant
Sense of
Belongingn
ess
Fun and
enjoyment
in life
Warm
relationship
with others
Self-
fulfillment
Being well
respected
Excitement
A sense of
accomplish
ment
Security
Self-
Respect
Based on the survey above, answer the following questions:

1. Was it easy to answer the survey? Explain.

________________________________________________________________
________________________________________________________________
________________________________________________________________

2. Was the instruction of the questionnaire clear? Explain.

________________________________________________________________
________________________________________________________________
________________________________________________________________

3. What changes are needed to improve the survey questionnaire given?

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

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 What is It

Lesson 3 Survey Questionnaire

 What is a survey questionnaire?

A questionnaire is a research instrument that consists of a set of questions
or other types of prompts that aims to collect information from a respondent. It is
more quantifiable compared to other types of research instruments.

 Parts of a Survey Questionnaire

1. Personal Information Section – includes the name (optional), age, date of birth,
address, educational background and other personal information about the
respondent. Note that only personal information relevant to the research study
should be asked.
2. Basic questions Section- serves two purposes. The first one is to establish that
the person you are asking is the right person for the study. The second purpose
(which is only applicable to interview) is to establish rapport with the interviewees.
3. Main questions Section – contains questions that are directly related to your
research. It is ideal to have multiple questions for each specific research questions.
The greater the number of questions, the greater the possibility of more conclusive
results.
4. Open-ended question section – asks for a brief explanation or response to an
open-ended question.

 Characteristics of Survey Questionnaire

1. Uniformity Questionnaires= Are very useful to collect demographic information,

personal opinions, facts, or attitudes from respondents. One of the biggest
characteristics of questionnaires is uniform design and standardization. Every
respondent sees the same questions. This helps in data collection and
statistical analysis of this data. For example, the retail store evaluation
questionnaire template contains questions for evaluating retail store
experiences. Questions relate to purchase value, range of options for product
selections, and quality of merchandise. These questions are uniform for all
customers.

2. Exploratory= To collect qualitative data, the questionnaire should be

exploratory. There is no restriction to questions that can be in your
questionnaire or the specific objective of the questions. For example, you use
a data collection questionnaire and send it to the female of the household to
understand her spending and saving habits relative to the household income.
Open-ended questions give you more insight and allow the respondents to
explain their habits. A very structured question list could limit the data
collection.
3. Question Sequence= A questionnaire typically follows a structured flow of
questions to increase the number of responses. This sequence of questions is
screening questions, warm-up questions, transition questions, skip questions,
difficult questions, and classification questions. For example, our motivation
and buying experience questionnaire template covers initial demographic

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 questions then asks for time spent in sections of the store as well as the
rationale behind purchases.

 Guidelines in Preparing a Survey Questionnaire

1. Introduce the questionnaire through a cover letter. The cover letter should
explain the purpose and relevance of the study, the length of time in completing
the questionnaire, how the data will be processed, your contact details, and
expected date and time in completing the questionnaire.
2. Keep the questionnaire as short as possible by focusing only on the
essential questions.
3. Ensure confidentiality of information.
4. Pilot the questionnaire to ensure that you have missed any important
question.
5. Use a follow-up reminder.
6. Give the respondents a sufficient time to answer the questionnaire.
7. Make all directions and questions clear and unequivocal; do not use words
with double meanings or complex questions.
8. Ensure that your grammar is correct.
9. Use questions that will elicit objective responses as much as possible.
10. Make the questionnaire as brief as possible without sacrificing content.
11. Arrange and categorize the questions logically (e.g. based on research
questions).
12. Relate all questions to your research topic and make sure the responses
drawn out are sufficient for your analysis.
13. In relation to the previous guideline, try to make as many questions as
possible without being redundant.
14. Avoid embarrassing, unnecessary questions.
15. Explain and illustrate difficult questions.
16. State questions affirmatively.
17. Make the respondent anonymous, if necessary.
18. Avoid biased and leading questions.

What’s More

SAMPLE SURVEY QUESTIONNAIRE

Customer Satisfaction on QRZ Family Restaurant
I. Introduction
Dear Customer, Good day! The QRZ Family Restaurant is dedicated to improving
customer satisfaction. Through this brief survey, your answers will be helpful in enhancing
our services and meeting your needs. Your response will only be used for survey
purposes. Attached is a meal coupon good for 3 months as a token of our good will. In
case you have any questions regarding the survey, please call Johnny Smith at 123-
4567890. Thank you very much for your time and suggestions.

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II. Personal Information
Name (optional):_________________________________
Age: ____
Gender: ____
Number of Family Members:
□ 1-2
□ 3-5
□ 6-10
□ more than 10

Email Address (optional): _______________________________

III. Questions
Directions: Please indicate your level of agreement or disagreement with each of these
statements regarding QRZ Family Restaurant. Place an "X" mark in the box of your
answer.
Q1: How many times per year do you visit QRZ Family Restaurant? ____
Q2: Do you visit QRZ Family Restaurant with family or friends? □ Yes □ No

Indicators Strongly Agree Neutral Disagree Strongly

Agree Disagree
1.The store is
accessibly
located.
2. Store
hours are
convenient
for my dining
needs.
3.Advertised
dish was in
stock.
4.A good
selection of
dishes was
present.
5. The meals
sold are a
good value
for the
money.

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 6. Store has
the lowest
prices in the
area.
7. Meals sold
are of the
highest
quality.
8. Store
atmosphere
and décor
are
appealing.

Q9: How would you rate your overall experience at the QRZ Family Restaurant?

□ Highly satisfactory
□ Satisfactory
□ Neutral
□ Unsatisfactory
□ Highly Unsatisfactory

Q10: What could we do to make your restaurant dining experience better?

_____________________________________________________________________
______________________________________________________________________

Thank you for sharing your thoughts with us. Enjoy dining at QRZ Family Restaurant.

What I Have Learned

EXERCISE 1 Tick the box before the statement which shows a good survey practice.
Paulina’s research is about sanitary practices in fast-food chains. In her
questionnaire, she asks about the love life of her participants.
For her research on teenage drug addiction, Justine interviews the sari-sari store
owner in her barangay.
Matthew thanked the respondents in his survey and offered them copies of his
completed research months afterwards.
Angelo used the data in his interview to blackmail one of his respondents.
Stacy tells her respondents that the survey keeps outmost confidentiality to the
answers they have given
Dante attached a letter to the questionnaire to explain the purpose of the conducted
research

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 What I Can Do
Write a sample survey of customer’s satisfaction on one fast food restaurant. The
survey needs to be complete in parts with introduction, personal information, main
questions and thank you statement. Let 10 people answer the survey created and
tally their responses.

__________________________________________________

I. Introduction

II. Personal Background

III. Questions

Indicators Strongly Agree Neutral Disagree Strongly

Agree Disagree
1.

2.

3.

4.

5. EXERCISE 2.2 TALLY OF RESPONSES

6.

Directions: Write the frequency/ number of responses for each choice (strongly agree,
agree, neutral, disagree, strongly disagree) in the six indicators based on the
questionnaires gathered from 10 people.

Example:
Indicators Strongly Agree Neutral Disagr Strongly Total
Agree ee Disagre
e
1. The foods served 5 3 1 1 0 10
are fresh and
delicious

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 Indicators Strongly Agree Neutral Disagree Strongly Total
Agree Disagree
1. 10

2. 10

3. 10

4. 10

5. 10

6. 10

Answer Key

C 5.
A 4.
A 3.
D 2.
A 1.
What I have Know

REFERENCES:

Jessie S. Barrot and Philippe John F. Sipacio, English for Academic and Professional Purposes
for Senior High School Quezon City: C & E Publishing, 2016.

Sarah Mae Sincero, “Questionnaire Example”, Explorable, accessed July 7, 2020,

https://explorable.com/questionnaire-example

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 Rubric: Questionnaire

Poor Fair Good

(1 pts) (3 pts) (4 pts)

The questions are The questions The questions are

difficult to sometimes are clear and precise,
understand, not clear and precise, collectively
Questions precise and collectively allowing for
ambiguous. allowing for detailed,
Questions are meaningful unambiguous and
interpreted in answers. meaningful
different way by Questions are answers.
respondents interpreted in the Questions are
same way by interpreted in the
respondents. same way by
respondents

All predefined All predefined All predefined

answers provided, answers provided, answers provided,
and their formats and their formats and their formats
Answers are not appropriate are not always are appropriate to
to the question. appropriate to the the questions. The
The number of question. The number of rating
rating scale number of rating scale options is
options is no scale options is adequate to the
adequate to the adequate to the questions
questions questions

Questionnaire There is not room There is room for There is room for
Form for people to add people to add people to add
additional additional additional
information, if they information, if they information, if they
need need need

Writing style is Writing style is Writing style is

Writing Style vague and not appropriate to the concise and
accurate or target audience accurate and
appropriate to the appropriate to the
target audience. target audience

Grammar The spelling, The spelling, The spelling,

grammar and grammar and grammar and
punctuation is not punctuation is punctuation is
accurate clear enough correct and
accurate

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For inquiries or feedback, please write or call:

Department of Education – Region VII- Tagbilaran City Division

Office Address: Rajah Sikatuna Avenue, Dampas, Tagbilaran City
Telefax: (038) 544- 2147; 427- 1702
E-mail Address: tagbilarancitydivision@yahoo.com

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