Broken Family Survey Questionnaire

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Broken Family Survey Questionnaire
Broken Family Survey Questionnaire
Surv ey Questionnaire “EFFECTS OF HAVING A BROKEN FAMILY” 1 . With whom y ou are liv ing with? Father Mother Guardian Others: ________________ 2 . Since when y ou experienced hav ing a broken fam ily ? ____y /o 3 . How m any siblings do y ou hav e? [pic] Only Child [pic] 2 [pic] 3 and abov e 4 . How m any friends do y ou hav e? [pic] 1 -3 friends [pic] 4 -7 friends [pic] 8 and abov e 5. What was y our first reaction when y ou knew that y our m om and dad will nev er be together? [pic] happy [pic] unhappy [pic] others: (pls. specify ) __________________________ 6 . Fill in the blank. My life will not be com pleted w/out m y _________. [pic] Mom [pic] Dad [pic] Others . . . why ? ____________________________________________________________ __ 7 . Was there any instances that y ou decided to liv e on y our own? [pic] Yes [pic] No 8. Is there

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