INFORMED CONSENT KK Survey Questionnaire Date:_____________

Katipunan ng Kabataan Profiling (KK Profiling) Respondent No. ____

Consulting Agency TO THE RESPONDENT: Good day!
National Youth Commission (NYC) We are currently conducting a study that focuses on assessing the demographic information of the
Quezon City, Philippines Katipunan ng Kabataan. We would like to ask your participation by taking your time to answer this
questionnaire. Please read the questions carefully and answer them accurately.
1. Purpose of the Study REST ASSURED THAT ALL INFORMATION GATHERED FROM THIS
The Profiling aims to gather the information and data of the Katipunan ng STUDY WILL BE TREATED WITH UTMOST CONFIDENTIALITY.
Kabataan members. The information that will be gathered in the KK Profiling
will be stored to the upcoming SK Portal and will only be used for the purpose I. Profile
of database management handled by the National Youth Commission. Name of Respondent:
2. Terms and Duration of Participation ____________________________________________________________________
You are asked to join the study as a participant in the KK Profiling. The Last Name First Name Middle Name Suffix
conduct of the profiling will take 2 to 3 hours per Barangay; the data will
serve as an updated National database of the Katipunan ng Kabataan Location:
members in the Philippines. ____________________________________________________________________
3. Risks/Confidentiality Region Province City/Municipality Barangay Purok/Zone
Your participation in the study will be treated with utmost confidentiality. Any
Sex Assigned by Male Age:_____________ Email Ad:______________
information collected from you will be used in the Database management. Birth: Female Birthday:__________ Contact #:______________
Also, your safety is our primary concern. The profiling ensures that there will (dd/mm/yyyy)
be no risk to encounter during the process of data collection.
4. Compensation II. Demographic Characteristics
Please put a Check mark next to the word or Phrase that matches your response.
The activity is in accordance with RA No. 10742 and the policy/guidelines Civil Status Youth Classification
of the Department of Interior and Local Government and the National Youth
Single Separated In School Youth Person w/ Disability
Commission. There will be no monetary remuneration other than our
Married Annulled Out of School Youth Children in Conflict w/ Law
sincerest gratitude for your time and effort. Your participation will be highly
appreciated. Widowed Unknown Working Youth Indigenous People
Divorced Live-in Youth w/ Specific Needs
5. Inquiries Youth Age Group
If you have any question/s on the administration of the survey question or the Educational Background
Child Youth (15-17 yrs. old)
study in general, please do not hesitate to contact the research proponent Elementary Level Employed Core Youth ( 18-24 yrs. old)
through the following information: Young Adult (25-30 yrs. old)
Elementary Grad Unemployed
High School Level Work Status Self-employed
__________________________
High School Grad Currently looking for a Job
SK Secretary
Vocational Grad Not Interested Looking for a Job
College Level Registered Yes
Confirmation Did you vote last Yes
College Grad SK Voter? No SK Election?
No
Name of Respondent:
Masters Level Registered Yes
Signature: Masters Grad If Yes, How 1-2 Times
National Voter? No many times? 3-4 Times
Date: Doctorate Level 5 and Above
Have you already
Contact Information Yes
Doctorate Graduate attended a KK
No If No, There was no KK
Assembly? Why? Assembly Meeting
Not Interested to Attend

Thank you for your participation!

_____________________________
Name and Signature of Participant