Appendix A Republic of the Philippines

Region X
Division of Misamis Occidental
District of Tudela
TUDELA NATIONAL COMPREHENSIVE HIGH SCHOOL
Basirang, Tudela, Misamis Occidental

LEARNER SURVEY FORM

Instructions:
1. This survey form shall be answered by the learner and his/her home study partner.
2. Please read the questions carefully and write your answers legibly in CAPITAL letters. For items not applicable, write N/A.
3. For questions/ clarifications, please call or text your class adviser or your science teacher (phone numbers are available in your
module).

A. LEARNER’S INFORMATION
Name Nick Name Grade
Place of Birth Date of Birth Gender

B. PARENT’S INFORMATION
FATHER
Name Age Occupation
Salary Educational Attainment Religion
MOTHER
Maiden Name Age Occupation
Salary Educational Religion
Attainment

C. HOME STUDY PARTNER’S INFORMATION

C1. Do you have study partners at home who can provide instructional support to your Self-learning
Modules?
YES NO
If YES, please answer C2, C3, & C4. If NO, please proceed to C5.
C2. Relationship to Home Study Partner
C4. Number of hours a home study partner can provide support
Mother
to learners in answering the Self-learning Module.
Father
1-2 hours per day
Elder sibling
3-4 hours per day
Grandparent
5-6 hours per day
Extended member of the family
7-8 hours per day
Others (tutor, house helper)
Other please specify:__________
C3. Highest Educational Attainment
C5. What instructional support available at home that the
Elementary Level
learner can use for learning? Check all that applies.
Elementary Graduate
Technology devices and internet connection
High School Level
Books
High School Graduate
Journals
College Level
Magazines
College Graduate
Others: ____________________
Vocational
Master’s Degree
Doctorate Degree
I hereby certify that the above information given are true and correct to the best of my knowledge and I allow
Tudela National Comprehensive High School to use my child’s details in the conduct of the teacher’s action research.
The information herein shall be treated as confidential in compliance with the Data Privacy Act of 2012.

Signature Over Printed Name of Learner Date

THE RESEARCH INSTRUMENT

Signature Over Printed Name of Home Study Partner

27 Date
Appendix B Republic of the Philippines
Region X
Division of Misamis Occidental
District of Tudela
TUDELA NATIONAL COMPREHENSIVE HIGH SCHOOL
Basirang, Tudela, Misamis Occidental

QUARTER 1-MODULES 2 & 3 ASSESSTMENT

RESPONDENTS’ PROFILE

Student's
Home Study Partner Involvement
Performance
Time
Name
Average Educational Rendered
Relationship
Grade Attainment in hour/
Day
Respondent 1 91 Elder Sibling College Level 1-2
Extended
member of
Respondent 2 84 the family High School Level 1-2
Respondent 3 92 Mother College Graduate 5-6
Respondent 4 92 Mother College Graduate 5-6
Respondent 5 90 Mother College Level 1-2
Respondent 6 89 Father Elementary Level 3-4
High School
Respondent 7 91 Mother Graduate 1-2
Respondent 8 89 Mother College Level 3-4
Respondent 9 84 Mother High School Level 7-8
Extended
member of
Respondent 10 81 the family High School Level 1-2
Elementary
Respondent 11 90 Mother Graduate 1-2
High School
Respondent 12 93 Mother Graduate 1-2
Respondent 13 94 Mother College Graduate 1-2
Respondent 14 89 Mother Elementary Level 1-2
High School
Respondent 15 88 Mother Graduate 1-2
Respondent 16 86 Elder Sibling College Level 3-4
High School
Respondent 17 86 Mother Graduate 1-2
Respondent 18 92 Elder Sibling High School Level 7-8
Respondent 19 88 Elder Sibling High School Level 3-4
Respondent 20 84 Father Vocational 3-4

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 Republic of the Philippines
Region X
Division of Misamis Occidental
District of Tudela
TUDELA NATIONAL COMPREHENSIVE HIGH SCHOOL
Basirang, Tudela, Misamis Occidental

Respondent 21 88 Elder Sibling High School Level 1-2

Extended
member of
Respondent 22 89 the family High School Level 1-2
Respondent 23 93 Classmate High School Level 3-4

Elder Sibling
Respondent 24 94 College Level 1-2
Father, Elder
Respondent 25 92 Sibling College Graduate 1-2
High School
Respondent 26 85 Mother Graduate 3-4
High School
Respondent 27 91 Elder Sibling Graduate 5-6
Mother & High School
Respondent 28 92 Father Graduate 5-6
Respondent 29 87 Grandparent High School Level 3-4
Extended
member of
Respondent 30 96 the family High School Level 1-2
Respondent 31 94 Elder Sibling High School Level 1-2
Respondent 32 92 Mother College Graduate 1-2
Extended
member of
Respondent 33 91 the family High School Level 1-2
Respondent 34 84 Mother High School Level 1-2
High School
Respondent 35 85 Mother Graduate 3-4
Respondent 36 88 Elder Sibling College Level 1-2
Respondent 37 86 Mother High School Level 1-2
High School
Respondent 38 91 Mother Graduate 3-4
Respondent 39 94 Father College Graduate 3-4
Respondent 40 90 Mother High School Level 5-6

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 Republic of the Philippines
Region X
Division of Misamis Occidental
District of Tudela
TUDELA NATIONAL COMPREHENSIVE HIGH SCHOOL
Basirang, Tudela, Misamis Occidental

March 7, 2024

GLENN D. CABATUAN
Secondary School Principal III
Tudela National Comprehensive High School
Tudela, Misamis Occidental

Dear Sir:

Greetings with Peace!

I, Grade 10 Science Teacher of Tudela National Comprehensive High School

would signify my intention to conduct research entitled “OPTIMIZING STUDENTS’
ACHIEVEMENT THROUGH SCIENCE INSTRUMENTATION STRATEGY”.

I am hoping for your approval regarding this matter. Thank you very much and
God bless.

Respectfully yours,

ELFLEDA G. PEREZ
Researcher

Recommending Approval:

DACELYN O. BOTANAS
District Research Coordinator

Approved

GLENN D. CABATUAN
Secondary School Principal III

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Appendix D
Republic of the Philippines
Region X
Division of Misamis Occidental
District of Tudela
TUDELA NATIONAL COMPREHENSIVE HIGH SCHOOL
Basirang, Tudela, Misamis Occidental

October 15, 2020

Dear Respondents,

Greetings with Peace!

I am a Grade 10 Science Teacher of Tudela National Comprehensive High School

and currently conducting a research entitled HOME STUDY PARTNER’S
EDUCATIONAL LEVEL IN RELATION TO STUDENT’S ACADEMIC
PERFORMANCE IN SCIENCE.

In this connection, I would like to ask your help to provide the necessary data for
my study, please feel free to answer the Learner’s Survey Form. Rest assure that your
participation will be kept confidentially and it will be much appreciated.

Thank you very much for your cooperation.

Very truly yours,

ELFLEDA G. PEREZ
Researcher

Noted by:

JULIET S. LAPIZ
School Principal I

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Appendix E
Republic of the Philippines
Region X
Division of Misamis Occidental
District of Tudela
TUDELA NATIONAL COMPREHENSIVE HIGH SCHOOL
Basirang, Tudela, Misamis Occidental

Letter to conduct a home visitation

32