Appendix C

The Questionnaire

Dear respondents
The undersigned are undergoing a study entitled
LIFESTYLE OF SENIOR CITIZENS. In this connection feel free
t o a n s w e r t h e a t t a c h e d q u e s t i o n n a i r e h o n e s t l y. R e s t a s s u r e d
y o u r c o n f i d e n t i a l i t y.
Thank you
Reasearcher
................................................................................
1 PROFILE
Direction: please fill out / check on appropriate blanks or
boxes.
(direksyon: paki tsek asin pakitao kan mga hinahagad na
datus)
Name (pangaran)

(optional)

a. Age (edad)
b . G e n d e r ( Taw o h a n )
Male (Lalake)
Female (Baba ye)

( )
( )

c. Civil status (Kamugtakan sa buha y):

Single (Daraga/Soltero)
Married (Ma y Agom )
Separated (Suway na sa agom)
Widow (Balo)

d. Religion (Relehiyon)

(
(
(
(

)
)
)
)

Catholic (Katoliko)
Others (Iba pa)

( )
( )

e. Educational Attainment(Tinapusan)

Elementary (Elementarya)
Highschool
College (Kolehi yo)

( )
( )
( )

f. Number of children (bilang kang aki)

g. Living arrangement (Sain nag istar)

With children (kaiba an aki)

Living with relatives

( )
( )

Appendix B
Letter to the Barangay Captain

Amando Cope College

College of Nursing
Tab a c o c i t y

April 2, 2016
Mr. Danilo Carillo
Barangay Captain
P a w a , Ta b a c o C i t y

Dear si r,
Greetings!
The undersigned Nursing student of Am ando Cope College
is presently conducting a study entitled Lifestyle of Senior
Citizens as a partial fulfilment of the requirements in Nursing
Research.
The data that will be obtained will improve present health
status of the senior citizens. Rest assured that all information
gathered would be kept confidential

We are hoping for your approval

Very trul y yo urs,

PEPITO IBRAHIM REGACHO

Letter to the Barangay Captain

Amando Cope College

College of Nursing
Tab a c o c i t y

April 2, 2016
Mr. Arnulfo Onrubia
Barangay Captain
T a y h i , Ta b a c o C i t y
Dear si r,
Greetings!
The undersigned Nursing student of Am ando Cope College
is presently conducting a study entitled Lifestyle of Senior
Citizens as a partial fulfilment of the requirements in Nursing
Research.
The data that will be obtained will improve present health
status of the senior citizens. Rest assured that all information
gathered would be kept confidential

We are hoping for your approval

Very trul y yo urs,

PEPITO IBRAHIM REGACHO

Appendix A
Letter to the Dean

Amando Cope College

College of Nursing
Tab a c o C i t y

April 2, 2016
Maria Renee O. Cope,RN, MAN, PhD
Dean, College of Nursing
Amando Cope College
Tab a c o C i t y
Dear si r,
Greetings!
The undersigned Nursing student of Am ando Cope College
is presently conducting a study entitled Lifestyle of Senior
Citizens as a partial fulfilment of the requirements in Nursing
Research.
In view of this, I would like to ask your permission to allow
me to conduct the distribution of my questionnaires to my
r e s p o n d e n t s i n Ta y h i a n d P a w a Ta b a c o C i t y . R e s t a s s u r e d t h a t
all information gathered would be kept confidential

We are hoping for your approval

Very trul y yo urs,

PEPITO IBRAHIM REGACHO