Dear Respondents,

We are bona fide students of Tanauan City College, taking up Bachelor of Technical-Vocational
Teacher Education. We are currently conducting a study entitled “Impact of the Academic Anxiety to
the Academic Performance of the Senior High School Students at Tanauan City College A.Y.
2018-2019”.
Rest assured that the information you provide will be used for this study alone and shall be treated
with confidentiality. We are truly grateful with your cooperation. Thank you and God bless.

The Researchers

Name (Optional): _________________________________ Grade & Section: _________________________

Put a check (√) on the space provided that corresponds to your General Weighted Average (GWA)
during the first semester.
____ 97 – 99 (1.00) ____ 85 – 87 (2.00) ____ 75 – 77 (3.00)
____ 94 – 96 (1.25) ____ 82 – 84 (2.25) ____ 72 – 74 (4.00)
____ 91 – 93 (1.50) ____ 79 – 81 (2.50) ____ 71 and below (5.00)
____ 88 – 90 (1.75) ____ 76 – 78 (2.75)

Directions: Below are indicators that describe different feelings and situations, especially those you might
encounter in school. The columns on the right presents scales 1 – 5, 5 is the highest while 1 is the lowest.
Please read each item carefully and check (√) the box which suits your answer for each indicator.

Strongly Agree Agree Neutral Disagree Strongly Disagree

5 4 3 2 1

1. PERSONAL 5 4 3 2 1
I feel....
1.1. bothered when important thoughts run through my mind
1.2. discouraged and feel like giving up when things go wrong
1.3. that insufficient family income will affect my academic
performance
1.4. anxiety about problems in my family
1.5. troubled when facing problems towards love with opposite sex
2. CLASSROOM
I feel....
2.1. uncomfortable because of my problems with my peers
2.2. anxious when participating and giving class presentation
2.3. nervous when the teacher is interrupting to correct and give inputs
2.4. my heart beating very fast when the teacher conducts recitation
2.5. anxiety when the teachers are reluctant to help me
3. TEST AND SUBJECT
I feel....
3.1. very panicky when I have to take a surprise test
3.2. anxious during a test due to the lack of preparation
3.3. stressed thinking about a coming test an hour before
3.4. anxious when I could not understand the lesson
3.5. anxious because the subject is difficult

Thank you very much!

Sources: Vitasari, P. (2010). A Research for Identifying Study Anxiety Sources among University Students
Pizzie, R. & Kraemer, D. (2017). The Academic Anxiety Inventory: Evidence for dissociable patterns of anxiety related to math and other
sources of academic stress