Questionnaire (Breastfeed Infants)

GENERAL INTRUCTION: Fill in the following information that is needed below.

Part I. Profile
Name (optional): _________________________
Age: _________
Sex: ______
Religion: _________________
Civil Status: ____________

Part II. Extent of Breastfeed infants.

The following are verbal interpretation of level scales for collected responses of
breastfed respondents.
4=highly evident
3=evident
2=less evident
1=not evident
Instruction: Please check what level of scale does your child belong.
Cognitive 4 3 2 1
highly evident less not
evident evident evident
 Is able to answer
 Is able to classify objects
 Is able to focus on multiple
aspects of situation
 Is able to think in terms of
present past and future events

Psychomotor 4 3 2 1
highly evident less not
evident evident evident
 No delay in physical
development
 Is able to respond according to
age
 Is able to exert stremous
activity
 Is able to run
 Is able to play game
 Affective 4 3 2 1
highly evident less not
evident evident evident
 Love of God
 Love of parents
 Love of peers
 Love of faith
 Love of environment
 Love of sportsmanship

Part III. Extent of Academic Performance

4 3 2 1
highly evident less not
evident evident evident
 Intellectual Capacity (IQ)
 Emotional Capacity (EQ)
 Productive relationship with
people
 Productive relationship with
environment
 Grades obtain from school
 Questionnaire (Non-breastfeed Infants)
GENERAL INTRUCTION: Fill in the following information that is needed in the below.
Part I. Profile
Name (optional): _________________________
Age: _________
Sex: ______
Religion: _________________
Civil Status: ____________

Part II. Extent of non-breastfeed infants.

The following are verbal interpretation of level scales for collected responses of
non-breastfed respondents.
4=highly evident
3=evident
2=less evident
1=not evident
Instruction: Please check what level of scale does your child belong.
Cognitive 4 3 2 1
highly evident less not
evident evident evident
 Is able to answer
 Is able to classify objects
 Is able to focus on multiple
aspects of situation
 Is able to think in terms of
present past and future events

Psychomotor 4 3 2 1
highly evident less not
evident evident evident
 No delay in physical
development
 Is able to respond according to
age
 Is able to exert stremous
activity
 Is able to run
 Is able to play game
 Affective 4 3 2 1
highly evident less not
evident evident evident
 Love of God
 Love of parents
 Love of peers
 Love of faith
 Love of environment
 Love of sportsmanship

Part III. Extent of Academic Performance

4 3 2 1
highly evident less not
evident evident evident
 Intellectual Capacity (IQ)
 Emotional Capacity (EQ)
 Productive relationship with
people
 Productive relationship with
environment
 Grades obtain from school