Jesel Mae's Group

INFORMED CONSENT FORM
Title of the Study: Effects of Social Media Addiction to Academic Performance of Grade 12
students in Hingatungan National High School.
Researchers: Jesel Mae R. Tulang, Daisy C. Siongco, Teovie F. Troyo, Edwin B. Tan
The researcher would like to invite you to be a researcher participant in the research study
entitled, “Effects of Social Media Addiction to Academic Performance” of Grade 12 students in
Hingatungan National High School.
Given that you meet the inclusion requirements for the study’s intended participants, you have
been selected as one of the participants. By participating, you will give the researchers
information. This study asks for your voluntary participation no penalties or actions will be taken
against you if choose to discontinue participating in this study at any time. In the event of
withdrawal of participation, the data you have provided will also be withdrawn and will not be
used in this study’s data analysis.
We can assure you that there are no known risks associated with your participation. If you agree
to let us use your participation in this study, we the researchers, will ask you some question
about the study. You will be given the option of doing the informal interview where and when it is
most convenient for you. Your participation in the interview, which can take up to 60 minutes,
will be recorded, typed up, and kept anonymous.
In Order to verify the consistency and similarity of the contents between your responses and the
decoded responses in the manuscript, the transcript from the survey questioner will be given to
you.
Your personal details will not be mentioned in any research study documents. Please feel free
to contact us at any time by phone at 0912-059-0876 if you have any questions about the
research study. Your signature confirms that after reading and comprehending the provided
information, you have made the decision to participate in this study as a research respondent.
You will receive a copy of this consent form to keep.
Regarding my involvement in this study, all of my question and worries have been fully
addressed. I willingly agreed to take part in this study.
Research participant Signature Mobile number Date

Department of Education
Region VIII
Division of Southern Leyte
District of Silago
Hingatungan National High School
Hingatungan Silago Southern Leyte
SURVEY QUESTIONNAIREON THE EFFECT OF SOCIAL MEDIA ADDICTION TO ACADEMIC PERFORMANCE

OF GRADE 12 STUDENTS IN HINGATUNGAN NATIONAL HGH SCHOOL
Dear Respondent;
To participate in the research study named “Effects of Social Media Addiction to Academic
Performance of Grade 12 GAS students in Hingatungan High School” the researchers would like to invite
you to participate in this study. You were selected as a participant in this study because you meet the
requirements for the study’s target participant. By participating you will provide the researchers rich
information that will help answer the problems in this study. This study asks for your voluntary
participation. You are free to stop taking part in this study whenever you want to, and there will be no
consequences or actions taken against you. If you decide to cancel your participation, the data you
provided will also be canceled and won’t be used in this study’s for data analysis.
Do you want to participate in this study?
Yes, I will participate
No
PART I: DEMOGRAPHIC INFORMATION
Name:
Sex:
Age:
PART II: ANSWER YES OR NO ONLY.
1. Do you use social media?

2. Do you consider yourself addicted to social media?
3. Do you use social media during class hours?
4. Do you think social media usage can be one of the reasons why students procrastinate?
5. Do you think that there is a withdrawal of personal interactions between you and your
friends when using it at school?
PART III: ENCIRCLE THE LETTER OF YOUR ANSWER.
1. How many social media accounts do you have?

a. 1-3 b. 4-6 c. 7-9 d. 10 above
2. What specific social media platforms do you use?
a. Facebook b. Instagram c. Twitter d. Others
3. How many times a day do you open your social media accounts?
a. Not everyday b. 1-3 times a day c. 4-10 times a day d. above 10 times a day
4. Approximately how many hours do you use social media every day?
a. 1-2 hours b. 3-4 hours c. 5-6 hours d. 6 hours above
5. When do you access media?
a. during class hours b. during free time c. social occasions
PART IV:
Direction: The following statement are common factors affecting academic performance, please indicate
how much you agree or disagree with the statement by putting a check in the box on the right side of
each statement. Remember, there are no right or wrong answers your answer will be kept strictly
confidential and you will not be identified.
5- STRONGLY 4- AGREE 3- NEUTRAL 2- DISAGREE 1-STRONGLY

AGREE DISAGREE
1. Addiction to
online social
networks is a
problematic
issue that
affects my
academic life.
2. Online social
networks
distract me
from my
studies.
3. Hours spent
online can
never be
compared to
the numbers
of hours I
spend reading.
4. There is no
improvement
in my grades
since I became
engaged into
these social
networking
sites.
5. I usually have
unlimited
access to
Facebook and
this has
affected my
academic
performance
negatively.
6. I engage in
academic
discussion on
twitter and
this has
improved my
academic
performance.
7. I make use of
WhatsApp to
disseminate
knowledge to
my classmate.
8. I Solely rely on
information
gotten from
Wikipedia to
do my
assignments
without
consulting
other
resources.
9. The usage of
Wikipedia for
research has
helped
improve my
Grades.
10. Engaging in
academic
forums on
Yahoo reduces
my rates of
understanding.
March 27, 2023
MARY LURY A. LAGUMBAY
PRINCIPAL-I
Hingatungan National High School
Madam;
We the Grade 12 Senior High School students of Hingatungan National High School are currently
conducting a research study entitled “Effects of Social Media Addiction to Academic Performance”. This
study aims to determine the Effects of Social Media Addiction to Academic Performance of Grade 12
GAS Students. In view of the foregoing statement, may we respectfully, ask your permission to
administer our research questionnaire to the Grade 12 GAS students as the identified respondents of
this study. Rest assured that any information acquired will be kept confidential and used for research
purpose only.
We are looking forward for a positive response to this letter. Thank you very much
Very truly yours,
Jesel Mae Tulang Daisy Siongco Teovie Troyo Edwin Tan
Lead Proponent Members Members Members
Action taken ( ) Approved
( ) Disapproved
MARIA LURY A. LAGUMBAY
Principal-I

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INFORMED CONSENT FORM

Research participant Signature Mobile number Date

SURVEY QUESTIONNAIREON THE EFFECT OF SOCIAL MEDIA ADDICTION TO ACADEMIC PERFORMANCE

Do you want to participate in this study?

Yes, I will participate

PART II: ANSWER YES OR NO ONLY.

1. Do you use social media?

PART III: ENCIRCLE THE LETTER OF YOUR ANSWER.

1. How many social media accounts do you have?

5- STRONGLY 4- AGREE 3- NEUTRAL 2- DISAGREE 1-STRONGLY

MARY LURY A. LAGUMBAY

Hingatungan National High School

Very truly yours,

Jesel Mae Tulang Daisy Siongco Teovie Troyo Edwin Tan

Lead Proponent Members Members Members

Action taken ( ) Approved

MARIA LURY A. LAGUMBAY

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