Republic of the Philippines

SOUTHERN LEYTE STATE UNIVERSITY – SAN JUAN CAMPUS

San Jose, San Juan, Southern Leyte 6611
website: www.slsu.slsuonline.edu.ph
email: slsu.sj@slsuonline.edu.ph
Contact Number: +639-355-192-852

I. PROFILE
Name of Student: Year & Section:
Course: Address:
Scholarship:

TES 2 Grantee Others, Pls specify:

DOST Not Applicable

CHED
II. STATUS AFTER TYPHOON ODETTE
1. PHYSICAL NEEDS
a. House
Totally damage Partially Damage No Damage
b. Food and Water
No food & water available Inadequate food & water available Enough food & water available
c. Clothing
No Extra Clothing Available Few Clothing Available Enough Clothing Available
d. Personal Hygiene
No personal hygiene available Few Personal Hygiene Available Enough Personal Hygiene Available

2. FINANCIAL/ECONOMIC NEEDS
a. Source of Income

Lost the source of income after typhoon.

Temporary loss of the source of income after typhoon.

Source of income is available even after the typhoon.

3. PSYCHOLOGICAL STATUS
a. Stress Scale
Please read each statement and choose a number from 0-3 which indicates how much the statement
applies to you over the couple of days after Typhoon Odette. Kindly answer honestly. There are no
right or wrong answers.
Applies to Applies to Applies to
Does not
me seldom me often me always
Apply to
Statement since the since the since the
me at all
typhoon typhoon typhoon
0 1 2 3
1. I found it hard to calm down
2. I tended to over-react to situations.
3. I felt that I was using a lot of nervous energy
4. I found myself getting restless and disturbed
5. I found it difficult to relax.
6. I was intolerant of anything that kept me
from getting on with what I was doing.
 7. I felt difficulties were piling up so high that I
could not overcome them.

4. Academic Status
Do you plan to enroll on SY 2021-2022 2nd Semester?

Yes Not yet

Please read each statement and choose a number from 0-3 which indicates how much the statement
applies to you over the couple of days after Typhoon Odette. Kindly answer honestly. There are no
right or wrong answers.
Applies to Applies to Applies to
Does not
me seldom me often me always
Apply to
Statement since the since the since the
me at all
typhoon typhoon typhoon
0 1 2 3
8. I found it hard to calm down
9. I tended to over-react to situations.
10. I felt that I was using a lot of nervous energy
11. I found myself getting restless and disturbed
12. I found it difficult to relax.
13. I was intolerant of anything that kept me
from getting on with what I was doing.
14. I felt difficulties were pilling up so high that I
could not overcome them.

b.