KK Survey Questionnaire
Respondent #:
TO THE RESPONDENT:
Good day!
We are currently conducting a study that focuses on assessing the demographic information of the 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.
REST ASSURED THAT ALL INFORMATION GATHERED FROM THIS STUDY WILL BE TREATED WITH UTMOST
CONFIDENTIALITY.
I. PROFILE
Name of Respondent:
Last Name
Location:
Sex
Assigned
by Birth:
7
CEBU
Region
Province
First Name
CARMEN
City/Municipality
MIddle Name
PUENTE
Baranggay
Male
Age:
E-mail address:
Female
Birthday:
Contact #:
(mm/dd/yy)
Religion:
II. DEMOGRAPHIC CHARACTERISTICS
Please put a Check mark next to the word or Phrase that matches your response.
Civil Status
Youth age
Group
Youth
Classification
Educational
Background
Single
Married
Widowed
Divorced
Separated
Annulled
Unknown
Live-in
Child Youth (15-17 yrs old)
Core Youth (18-24 yrs old)
Adult Youth (25-30
In School Youth
Out of School Youth
Working Youth
Youth with Specific needs: Person with disability
Youth with Specific needs: Children in Conflict with the Law
Youth with Specific needs: Indigenous People
Elementary Level
Elementary Grad
Junior High School Level
Junior High School Grad
Junior High School Level
Senior High School Grad
College Level
College Grad
Master’s Level
Master’s Grad
Doctorate Level
Doctorate Grad
NONE
Others:
Suffix
SON-OC
Purok/Zone
Date:
Work
Status
Registered
Sk Voter?
Employed
Unemployed
Self-Employed
Currently Looking for a job
Not interested in looking for a job
Cebuano/Bisaya
English
Filipino
Other:
Yes
No
Registered
National Voter?
Yes
No
Did you vote
last SK
Elections?
Yes
No
Have you
already
attended a KK
Assembly?
Yes
No
If Yes, how
many
times?
Preferred
Language
during
Seminars
1-2 times
3-4 times
5 and above
If No,
why?
There was no KK Assembly
Not interested to attend
*Isip usa ka batan-on, unsa ang problema nga angay dapat gahinan ug panahon sa atong
barangay? (YOUTH DEVELOPMENT CONCERNS)
*Pagpili ug lima(5) nga importante para nimo dinhi sa 10 CENTERS OF YOUTH PARTICIPATION
Health
Education
Economic Empowerment
Social Inclusion and Equity
Governance
Active Citizenship
Environment
Global Mobility
Agriculture
Other:
Thank you for your participation!
Name and Signature of Participant