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*Adapted from the work of Czerniak & Chiarelott (1984), “Science Anxiety: An Investigation of Science
Achievement, Sex and Grade Level Factors”.
SURVERY QUESTIONNAIRE ON STUDENT ANXIETY LEVEL TOWARDS LEARNING OF
SCIENCE SUBJECT AMONG SENIOR HIGH SCHOOL STUDENTS
Respondent Number:
EMOTIONAL/BEHAVIORAL FACTORS
___✓___ Doesn’t like the topics/content in
science
______ Trauma from past experiences
______ Perception that science is difficult
______ Teacher attitude or way of teaching
___✓___ Parent attitude/expectation
towards their student
BIOLOGICAL FACTORS
______ Health problems/issues
______ Genetics (anxiety present in your
bloodline)
SOCIOECONOMIC FACTORS
__✓____ Family problems
______ Socio-economic background
______ Home & school location