Notre Dame of Midsayap College 1

College of Criminal Justice Education

Midsayap, Cotabato

QUESTIONNAIRE SURVEY

FACTORS AFFECTING THE SCHOOL RELATED OFFENSES OF THE SENIOR

HIGH SCHOOL STUDENTS OF NOTRE DAME OF MIDSAYAP COLLEGE:
BASIS FOR A PROPOSED INTERVENTION SCHEME

Part I. Personal Profile: Supply the needed information by checking (√) the
answer for your choices below:

1. Name (Optional)___________________

2. Age: ( ) 16-18 yrs. ( ) 19-20 yrs. ( ) 21-22 yrs.

3. Gender: Male ( ) Female ( )

4. Economic Status: Please check (√) the choices that correspond to your
answer below:

Monthly Income the Family:

Below Php 10,000 ( )

Php 15,000 up to Php 30,000 ( )
Php 30,000 up to Php 45,000 ( )
Php 45,000 and above ( )

Others, Please Specify: _________________

 Notre Dame of Midsayap College 2
College of Criminal Justice Education
Midsayap, Cotabato

Part II. Factors Affecting the School Related Offenses of Senior High
School Students of Notre Dame of Midsayap College

The scale below shows how often you interact with the following indicators
below, please check (√) the number that corresponds to your answers.

Scale:

Numerical Equivalent Verbal Description Descriptive level

5 Strongly Agree if the factors related to
school offenses is very high

4 Agree if the factors related to

school offenses is high

3 Moderately Agree if the factors related to

school offenses is moderate

2 Disagree if the factors related to

school offenses are low

1 Strongly Disagree if the factors related to

school offenses is very low

Instruction: Please check the box that corresponds with your chosen answer.

Personal 5 4 3 2 1
1. Do you like social gatherings?
2. Are you friendly at times?
3. Do you prefer to have any vices?
4. Do you find yourself aggressive?
5. Were you always absent in school?

Family 5 4 3 2 1
1. Do you have quality time with your family?
2. Are they strict in implementing rules?
3. Do you fear your parents?
4. Are you being dependent on your parents?
5. Do your parents exhibit violence?
 Notre Dame of Midsayap College 3
College of Criminal Justice Education
Midsayap, Cotabato

Environment 5 4 3 2 1
1. Does your community see you as a bad person?
2. Do you find your friends influential?
3. Do you perform in school poorly?
4. Bad Habit (Truancy, Absenteeism)
5. Do you have a belief or an ideology for violence?

Media 5 4 3 2 1
1. Do you love watching televisions which contains violence or violent
acts?
2. Do you spend so much time watching movies with violence?
3. Do you love playing videos games?
4. Do you find it influential to you the violent acts you saw on
television and movies?
5. Do violent acts in television and movies disturb you?