SURVEY QUESTIONNAIRE
Name of Respondent: ______________________________________________
1. Age of the Respondent: ___________________
2. Gender: Male Female
3. Marital Status: Single Married Solo Parent/Separated widow/er
4. Occupation:
Student: Full time Student w/ part time job
Employed: Government
Permanent Casual Seasonal Job-order/contractual
Private
Permanent Casual Seasonal Job-order/contractual
5. Source of Income:
Salary/Wages Part time Jobs Allowance from Family Others (please specify):_________
6. Average Monthly Income: ₱_____________ Average Monthly Expenses:
₱____________
7. Where do you usually take your snacks while at work or in school?
1. ______________________________________
2. ______________________________________
3. ______________________________________
4. ______________________________________
5. ______________________________________
Reasons of choosing from these sources:
1. ______________________________________
2. ______________________________________
3. ______________________________________
4. ______________________________________
5. ______________________________________
8. What food snacks did you usually buy from these sources?
1. ______________________________________
2. ______________________________________
3. ______________________________________
4. ______________________________________
5. ______________________________________
Reasons of choosing these products:
1. ______________________________________
2. ______________________________________
3. ______________________________________
4. ______________________________________
5. ______________________________________
9. How many times in a week do you usually buy snacks? _______________
10. On the average, how much did you spend for a snack in a week? ₱______________
11. Are you already satisfied/contented with these existing sources available in the locality or
would it be better it there is one store that may offer almost all native delicacies that you
usually availed of?
Contented w/ the 1st option Want the 2nd option
Reason/s of your choice:
1. ______________________________________
2. ______________________________________
3. ______________________________________
4. ______________________________________
5. ______________________________________
12. How many times you may possibly visit/order food snacks from the store in a week?
___________
13. With the number of possible visits/orders in a week, please select among the food/drinks
choices below that you prefer to avail/buy and the corresponding quantity per visit
Foods Number of Visit/Quantity Per Visit
Qnty Qnty Qnty Qnty Qnty Qnty Qnty
during 1st during during during during during during
visit 2nd visit 3rd visit 4th visit 5th visit 6th visit 7th visit
Biko
Niluyang
Pitchi-pitchi
Suman
Champorado
Kalamay-hati
Ube halaya
Kutsinta
Bibingka
Casava cake
Baye-baye
Kokoy
Palagsing
Pinintos
Empanada
Puto balanghoy
Maja balnaca
Puto Bongbong
Ube turon
Taho
Halo-halo
Ice candy
Mais Con Yelo
Dinuldog
Pospas
Drinks Number of Visit/Quantity Per Visit
Qnty Qnty Qnty Qnty Qnty Qnty Qnty
during 1st during 2nd during 3rd during 4th during 5th during 6th during 7th
visit visit visit visit visit visit visit
Native Coffee
Instant Coffee
Freshly Brewed
Coffee
Buko Juice
Soft Drinks
Fresh Fruit
Juice
Juice
Fruit Shakes
Fruit Mix
Thank you very much!
