APPENDIX A

SURVEY FORM
! Greetings
Thank you
for participating in this survey. Be assured that the information you will share will be treated
with utmost confidentiality and will be used solely for research
The Researcher
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APPENDIX B
Part I Personal Background
Directions: Please provide answers to the following questions as completely as possible.
A. Personal Background:
1. Full Name:______________________________ Age: _______ Birth place:____________
2. Home Address _____________________________________________________________
House No.
Street
Barangay
_______________________________________________________
District
City/town
Province Tel. No./Mobile No.
3. Father 's Name_____________________________________ Living? Yes [ ] No [ ]
Occupation:
_________________ Monthly income: [if there's any] ____________
Provincial Address:______________________________________________________
City Address:___________________________________________________________
4. Mother's Name____________________________ Living? Yes [ ] No[ ]
Occupation:
__________________ Monthly income: [if there's any] ____________
Provincial Address:______________________________________________________
City Address:___________________________________________________________
Number of siblings:_________ your ordinal position from among the siblings_______
B. Educational Background: [pls provide answers to items that follow to indicate name of
school graduated from and special award received and school year completed]
5. Elementary:__________________________Special award _______________________
6. Secondary:__________________________ Special award _______________________
7. Tertiary:________________________ ____Special award _______________________
[other school before ZCSPC if any]____________________________________________
8. Course applied upon admission to ZCSPC:______________ [ academic year]_________
9. Did you apply for any scholarship upon admission to ZCSPC Yes [ ] No[ ]
[If your answer to # 9 is yes, pls proceed to the next item. If no proceed to item:____________
. 9. Parents highest educational attainment: Please mark a [ /] one of the choices below.
10. 1 Father: [ ] elementary [ ] secondary [ ] tertiary [ ] others pls specify:
________________
10. 2 Mother: [ ] elementary [ ] secondary [ ] tertiary [ ] others pls specify:
________________

Pls. specify the scholarship program you have applied

for:___________________________________________________________________Did you
pursue the application? [ ]Yes [ ]No
and thus benefit the chance to get educational assistance in this institution.