“Causes of a Broken Family and Its effects to the emotional condition of the students on the selected schools in Manila” Name: _______________________________ Age: _________Sex: _________
Civil Status: ___________ Occupation: _______________________ Year Level: ____________
School [optional]: ______________________________________________
Direction: Kindly answer the following questions given.
1. What causes your family that made them separated?
____ Third Party/Affair____ Financial Problem____ Vices____ Others
2. Whose side are you with?
___ Mother___Father___Uncle/Auntie___Grand Mother/Grand Father
3. How does it affect you to have a broken family?
4. Do you handle it well? ____ Yes____ No
5. How do you handle this kind of situation?
6. Are you aware of how important family is?____ Yes____ No
7. Do your father or mother has another family?____ Yes____ No
8. Do you still respect your parent who made your family broken?____ Yes____ No
9. How does it affect your relation with your parents?
10. Is there a time that you are ashamed with what happened to your family? ____ Yes ____ No
11. What are the actions of your parents to solve these problems?
12. Does having a broken family affect your daily living?____ Yes____ No
13. How does it affect to your study?
14. How does it affect to you financially?
15. Does your parent support you from activities regarding in your studies? ____ Yes ____ No
16. What are the actions of your grandparents to this problem?
17. Does it...