EVALUATION FORM

Name(optional):
Age: Grade Level:
RESEARCH TITLE: Effects of Family Problems to The School Performance of Junior
High School Students
This questionnaire asks questions about your experience in family problems and
how it affects your school performance. It starts and ends with some questions about your
struggles and experiences to when it comes to family problems and contains other
questions on how you overcome to that particular problems. Thank you for your
participation.
Instructions:
Very often Often Sometimes Occasionally Never
1. How often do you
experience family
problem?

2. In your family do
you discuss
principles and
behavior norms?

3. In your family is
everyone’s opinion
taken into account
when making
discussions in the
family

4. Is having meals
together valued in
your family?

5. Doing things
together matter to
you as a family?

6. In your family is
it is important to
forgive those who
upsets you?
Please check the box honestly based on what you actually do given the statements using
the following

Yes No
1. Do you take family problem
seriously?
2. Does family problems affect
your academic performance?

3. Does family activity aids your

relationship inside your
family?
4. Do you talk to God about the
problems inside your family?
5. Do you open up to other
people about the problem in
your family?
6. Do you use social media to
cope up towards family
problem?