Thesis Survey

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SAMPLE SURVEY FORM

Republic of the Philippines


CAVITE STATE UNIVERSITY
Don Severino De Las Alas Campus
Indang, Cavite, Philippines, 4122

College of Arts and Sciences


Department of Social Sciences an Humanities

Dear Respondents,

Good Day! I am Louis Abegail V. Diesta, a 4th year BA Political Science student of
Cavite State University. I am conducting a research study on “THE PREVAILING
INSIGHTS TOWARDS THE SUBSTITUTE BILL NO. 7303: AN ACT
INSTITUTING ABSOLUTE DIVORCE AND DISSOLUTION OF MARRIAGE
IN SELECTED BARANGAYS OF INDANG, CAVITE”

This survey questionnaire is divided into two parts. Part I deals with the respondents
demographic profile and Part II deals with the prevailing insights towards the absolute divorce bill.
(Itong survey na ito ay nahahati sa dalawang bahagi. Ang ikaunang bahagi ay tumutukoy
sa demograpikong detalye ng mga sumasagot sa pananaliksik at ang ikalawang bahagi ay
tumutukoy sa nangingibabaw na pananaw ukol sa panukalang batas sa ganap na diborsIyo)

Part I. Participants Profile


Name:_______________________________ Years of Residency:______________________
Address:_____________________________ Educational Attainment:__________________
Years married:_______________________ Religion:_______________________________
NOTE: The survey will only take about 8-10 minutes AND THE INFORMATION THAT YOU
WILL PROVIDE WILL BE USED TO DETERMINE THE APPLICABILITY OF DIVORCE IN
THE PHILIPPINES. The information that you will provide is strictly confidential and for
academic use only. Thank you for your kind participation.
(TANDAAN: Ang pananaliksik ay tatagal mula 8 hanggang 10 minuto AT ANG
IMPORMASYONG IBIBIGAY AY MAGAGAMIT UPANG MAKATULONG SA PARA SA PAG
TIYAK NG PAGKAKA AKMA NG GANAP NA DIBORSIYO SA PILIPINAS. Ang impormasyong
ibibigay ay kompidensyal at para lamang sa pag aaral ng pananaliksik. Maraming salamat sa
inyong pakikilahok.)

PART II. Instruction. Put a check on the box that best describe your answer.
(Tagubilin. Maglagay ng tsek sa kahon na pinakamahusay na naglalarawan sa iyong sagot.)
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Disagree
1 - Strongly Disagree

5 4 3 2 1

1. Early marriage is a determinant of marital separation.


(Ang pagpapakasal ng maaga ay nagiging sanhi ng
paghihiwalay ng magasawa)

2. Physical abuse is a reason married couples decide to


separate.
(Ang pisikal na pananakit ay nagiging sanhi ng
paghihiwalay ng magasawa)

3. Financial breakdown is a determinant of marital


separation.
(Ang problemang pinansyal ay nagiging sanhi ng
paghihiwalay ng magasawa

4. The divorce bill will help those married couples in


irreconcilable marriage.
(Makakatulong ang diborsiyo sa mga mag asawang nasa
relasyong hindi na maaayos pa)

5. It is necessary for us to have a divorce law.


(Kelangan natin ng batas ukol sa diborsiyo)

6. The process of annulment, legal separation and


declaration of nullity takes too long and is too expensive.
(Masyadong mahal at matagal ang proseso ng annulment,
legal separation at declaration of nullity)
7. Religion is a factor that hinders the approval of the
divorce bill of becoming a law.
(Ang relihiyon ay nagiging sanhi sa hindi pagusad sa
panukalang batas sa diborsiyo)
8. Marriage will lose its essence once the divorce bill
becomes a law
(Mawawalan ng saysay ang kasal pag nagkaroon ng
diborsiyo)

9. Divorce should not be an option and should be avoided.


(Ang diborsiyo ay dapat iwasan)

10. Philippines is ready for a divorce law.


(Handan a ang Pilipinas sa panukalang batas sa
diborsiyo)

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