The Sports Coach as Educator Using Sports Learning to Cultivate

Academic excellence of Students

Sports Questionnaire

PART I. DEMOGRAPHIC PROFILE OF THE PARTICIPANTS

Instruction: Please answer the following questions and put check (√) in the
appropriate box corresponding to your answer.

Name (optional):

Age: ____________

Gender: _____________

Educational Attainment: _____________

Grade Level: __________________

I. To be completed by athlete and parent Yes No

1. Have you ever had an illness that:
a. required you to stay in the hospital?
b. lasted longer than a week?
c. caused you to miss 3 days of practice or a competition?
d. is related to allergies? (i.e., hay fever, hives, asthma, insect
stings)
e. required an operation?
f. is chronic? (i.e., asthma, diabètes, etc.)
2. Have you ever had an injury that:
a. required you to go to an emergency room or see a doctor?
b. required you to stay in the hospital?
c. required x-rays?
d. caused you to miss 3 days of practice or a competition?
e. required an operation?
3. Do you take any medication or pills including herbal
supplements?
4. Have any members of your family under age 50 had a
heart attack, heart problem, or died unexpectedly?
5. Have you ever:
a. been dizzy or passed out during or after exercise?
b. been unconscious or had a concussion?
6. Are you unable to run a half-mile (2 times around the track)
without stopping?
7. Do you:
a. wear glasses or contacts?
b. wear dental bridges, plates, or braces?
 8. Have you ever had a heart murmur, high blood pressure or a
heart
abnormality?
9. Do you have any allergies to any medicine?
10. Are you missing a kidney?
11. Have you ever used diet pills?
12. For Women
a. At what age did you experience your first menstrual period?
b. In the last year, what is the longest time you have gone
between periods?
EXPLAIN ANY "YES" ANSWERS

II. Officiating:
Strongly Strongly
Disagree Agree
Disagree Agree
1 I can easily take-charge during officiating
I remain calm under pressure during decision
2
making
3 I misjudged situations
4 I handled situations smoothly
5 I turn plans into actions

III. Certification

1. Did you attend training programs prior to officiating?

 Yes  No
2. Did the training helped you become excellent in officiating?
 Yes  No
3. Does your license is updated for officiating?
 Yes  No
4. Have you been officiating for the past years?
 Yes  No
5. Do you upgrade your certification once in a while?
 Yes  No

IV. Training:

1. Does training helps you improve coaching style?

 Yes  No
2. How often training program conducted in your area?
 Monthly  Every Quarter
 Half Yearly  Once a Year
3. Does training helps to increase motivation level being a coach?
 Yes  No
4. Does training enable coaches to be more productive?
 Yes  No
5. Does training method focus in developing your skills?
 Yes  No
Date:

Signature of athlete:

Signature of parent: