Survey CuesLlonnalre

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unlverslLy of Lhe AssumpLlon


School Age
Cender


1 WlLh whom you are llvlng wlLh?
MoLher laLher CLhers
2 Slnce when you experlenced havlng a broken famlly?
y/o
3 uld you goL angry wlLh your parenLs when Lhey separaLed?
?es no
4 uld you rebel agalnsL your parenLs?
?es Pow?

no Why?
3 ls Lhere any clrcumsLances LhaL you personally approach your parenLs and ask whaL
happened Lo Lhelr relaLlonshlp?
?es no
6 WhaL ls your ldea/s why Lhelr relaLlonshlp does noL work?
llnanclal problem
3
rd
arLy
roblem wlLh relaLlves
CLhers
7 uo you have any communlcaLlon wlLh your Mom/uad?
Mom uad none (lf none proceed Lo number 8)
8 lf yes do Lhey supporL you?
ln flnanclal aspecLs
ln emoLlonal aspecLs
none
9 Pow dld you accepL Lhe facL LhaL your parenLs are separaLed?


10 Who helped you Lo move on from you parenLs separaLlon?

11 WhaL ad[usLmenLs you've been Lhrough?

12 uld you have lnsecurlLles slnce your parenLs goL separaLed?
?es Why?
none
13 ls lL dlfflculL Lo llve a llfe wlLh a broken home? Why?


14 WhaL are your advanLages of havlng a broken famlly?
More lndependenL
More responslble
CLhers
13 WhaL are your dlsadvanLages of havlng a broken famlly?
Less care
ALLenLlon wlll be lessen
negaLlve effecL on Lhe sLudy
CLhers