Disruptive Behavior Questionnaire Page 1



THE EFFECTS OF DISRUPTIVE BEHAVIOR TO THE SCHOOL PERFORMANCE OF GRADE IV & V PUPILS IN CABANGLASAN DISTRICT
Chapter 1; CHAPTER IICHAPTER IIIChapter -4Chapter V

APPENDIX A

A QUESTIONNAIRE ON FACTORS ASSOCIATED WITH DISRUPTED VEHAVIOR AFFECTING THE SCHOOL PERFORMANCE OF GRADE IV
&   V PUPILS OF OLD CABANGLASAN ELEMENTARY SCHOOL.

Information Data
(Please fill in the following information)

I - Personal Data

1.1   Name:  __________________________

1.2    School where you are teaching:  ________________________

1.3   Brief description on how you are attached to the child.


     1.3.1              Teacher In charge

      1.3.2             Teacher (adviser)

    1.3.3              Subject Teacher
 

1.3.4              Others (specify)  ________________


Name of the pupil (having disrupted attitude optional):  ________________

Grade of the pupil: _________________


II- Disruptive Behavior to the school performance of Grade IV & V pupils in Old Cabanglasan Elementary  School.

Direction: Below are items for disruptive behavior of Grade IV & V pupils that you have possibly met as a teacher.     Indicated the extent of seriousness of each problem by encircling the options on the right of each item.     The options 5, 4, 3, 2, and 1 represent the seriousness of each problem, thus;

5- very very serious problem

4-very serious problem

3- serious problem

2-less serious problem


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