Broken Family Questionnaire

Topics: Mother, Family, Father Pages: 2 (306 words) Published: March 6, 2013

“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...
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