Republic of the Philippines

Department of Education

Name : ____________________________ Grade & Section: ______________________________

Subject: PE and Health 3-GRADE 12 Date: ________________________
Concept No. Skills/ Exercise/ Drawing / Art Learning Modules

PEH12 Quarter 2-Module 2 Week 5

III. PRE-ASSESSMENT:
A. Social Dancing Participation Questionnaire
Directions: Tick the column that best describes your participation in the activities below.

Social Dancing Activity Always Seldom Never

1. I actively participate in social dancing activities in
my community
2. I am a member of the grand cotillion dance
performed in a friend’s debut/social gathering.
3. I wear proper attire in social dancing activities.

4. I am confident in performing social dances in and

outside the school.
5. I insist in doing a dance combination that my
partner could not follow.
6. I don’t follow the lead of my partner because I have
my own style of dancing.
7. I dance vigorously whenever I participate in social
dancing activities.
8. I recognize the advantages of my engagement in
social dancing activities to my fitness and well-
being.
9. I share my social dancing skills with my friends,
family and community.
10. I enjoy participating in social dancing activities.

Guide Questions:

Summarize in few sentences what the survey revealed about your fitness habits
and attitudes toward social dancing. Write your summary in your answer sheet.

SURVEY SUMMARY:
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