SURVEY QUESTIONNAIRE IN SCIENCE
Republic of the Philippines
Department of Education
Region VII, Central Visayas
Guihulngan City Division
Guihulngan National High School – Poblacion
Survey Questionnaire
General Directions: This questionnaire intends to assess your information retention level in
Science in relation to the researchers’ study on “Digital vs. Handwritten Notes: Their Effects on
Information Retention in Science of Special Program Students”. The first part of the questionnaire
entails your personal information. However, the second part assesses your information retention level.
Please read the directions carefully for each part of the questionnaire. Your honest responses will be of
great help to the success of this research undertaking.
I. Personal Profile
Directions: Please tick the box that corresponds to the data that applies to you.
Age:
below 14 16 and above
14 - 15
Gender:
Male Female Other (specify)_________
II. TEST PROPER 3. This serves as a channel for signals
Directions: This retention test aims to between the brain and the rest of the body?
determine which method helps Grade 10 Special A. brain
Programs Students remember their science B. body
topics better: using digital note-taking or C. neurons
handwritten note-taking. Read each item D. spinal cord
carefully and encircle the letter of the correct 4. What does the autonomic nervous system
answer for each question. control?
A. body transmission of scents
1. What is nervous system? B. involuntary actions like heartbeat
A. It is part of the human body. C. signals carried throughout the body
B. It is the body's control center. D. voluntary actions like walking
C. It regulates body hormones. 5. What are nerve signals?
D. It transports blood throughout the body. A. flashing red lights
2. What is another term for nerve cell? B. large flashing green lights
A. cancer C. electrical impulses
B. ganglion D. type of hormones
C. mitochondrion 6. What are the main parts of the nervous
D. neuron system?
A. arteries, veins, and capillaries
B. brain, spinal cord, and nerves
C. hands, feet, and tongue
D. nose, toes, and tongues 14. Which of the following is TRUE about
7. Which part of the brain helps keep your synapse?
balance so you don't just fall or stumble I. A connection between a neuron and another
while walking? neuron
A. cerebellum II. The site of transmission of electric nerve
B. medulla oblongata impulses between neurons
C. pituitary gland III. An automatic response to a stimulus
D. spinal cord IV. It is considered as the control system of the
8. Which of the following is TRUE about the body
central nervous system? A. I only
A.It can be classified as somatic and autonomic B. I and II only
nervous system. C. I, II and III
B. It is composed of the brain and spinal cord. D. I, II, III, and IV
C. It is composed of the brain, spinal cord, and
hormones.
D. It is composed of cranial and spinal nerves.
9. Instructions from the brain to the target
organs are carried by ______.
A. receptors
B. nerves
C. sense organs
D. hormones
10. It refers to the state reached when each
part of the body functions in equilibrium with
other parts.
A. feedback
B. homeostasis
C. impulse
D. unstable
11. Which nervous system controls the
internal organs?
A. autonomic
B. central
C. peripheral
D. somatic
12. The hypothalamus connects the two
systems, _____ and _____
A. cardiovascular, urinary
B. circulatory, nervous
C. nervous, endocrine
D. nervous, respiratory
13. What part of a neuron carries the impulse
toward the cell body?
A. axon
B. cell body
C. dendrite
D. nucleus
