QUESTIONNAIRE

Please do not write your name on the questionnaire to ensure the confidentiality of your
responses. Please omit any questions you do not wish to answer. Please feel free to add
comments or clarifications to any of the questions. Thank you for your cooperation.
I.
Students Profile
Name (Optional): ________________________________________________________________
Age: ______________________
Gender: __________________
( ) Male
( ) Female
Civil Status:
( ) Single
( ) Married
Monthly Family Income
( )
( )
Area of Origin
( ) Urban
( ) Rural

4. Do you consider yourself to be a member of a minority group?

Yes-------1( )
No--------2( )
8. Approximately what is (was) the population of your hometown or city growing up and
presently?
Growing Up Hometown Now
Rural under 1,000--------------------1( )-----------1( )
1,000 - 4,999------------------------2( )-----------2( )
5,000 - 9,999------------------------3( )-----------3( )
10,000 - 19,999----------------------4( )-----------4( )
20,000 - 49,999----------------------5( )-----------5( )
50,000 - 99,999----------------------6( )-----------6( )
100,000 - 499,999--------------------7( )-----------7( )
500,000 - 999,999--------------------8( )-----------8( )
Over 1,000,000-----------------------9( )-----------9( )
9. What is your current marital status?
Single---------1( )
Married--------2( )
Separated------3( )
Divorced-------4( )
Widowed--------5(

4. Approximately, what was the population of your hometown/city you grew up in?
Rural area under 1,000 -----------------------------1q
1,000-4,999-----------------------------------------2q
5,000-7,999-----------------------------------------3q
8,000-10,999 ---------------------------------------4q
11,000-14,999 --------------------------------------5q

15,000-29,999 --------------------------------------6q
30,000-49,999 --------------------------------------7q
50,000 and over ------------------------------------8q
5. What is your religion?
Anglican------------------------------01q
Baptist --------------------------------02q
Buddhist ------------------------------03q
Jewish --------------------------------04q
Muslim -------------------------------05q
Other Protestant ----------------------06q
Presbyterian ------------------------------- 07q
Roman Catholic --------------------------- 08q
United ------------------------------------- 09q
None --------------------------------------- 10q
Other (please specify________________
6. What is (or was) your fathers main occupation? (e.g., teacher, carpenter, etc.)
Job __________________________________________________________
Brief Job Description____________________________________________
_____________________________________________________________
7. What is (or was) your mothers main occupation? (e.g., social worker, sales clerk, etc.)
Job __________________________________________________________
Brief Job Description____________________________________________
_____________________________________________________________

1.
2.
3.
4.
5.

Name:
Age:
Name of online program:
Name of university:
First Language:

13. I feel comfortable in solving math problem:

a) Yes b) No c) To some extent
17. As a student, I like to work in group activities:
a) Yes b) No
Thanks for filling the form completely. On the basis of your answers, we shall return to you with
the evaluation results in a weeks time. Please fill in your address and phone number:

Address:
Phone: