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  • Parents Mental Health Survey

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    Emelyn Manahan Salvador
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    The document is a parent mental health survey form from Burgos National High School. It includes a note from the counselor explaining that the guidance and counseling office wants to conduct a survey to better understand how parents are feeling about themselves, others, and difficult situations. The form asks parents to provide contact information and then rate how 21 statements about feelings of anxiety, stress, sadness, and worry apply to them over the past few days. The ratings are on a scale from 0 to 3 indicating how often each statement applies.

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    The document is a parent mental health survey form from Burgos National High School. It includes a note from the counselor explaining that the guidance and counseling office wants to conduct a survey to better understand how parents are feeling about themselves, others, and difficult situations. The form asks parents to provide contact information and then rate how 21 statements about feelings of anxiety, stress, sadness, and worry apply to them over the past few days. The ratings are on a scale from 0 to 3 indicating how often each statement applies.

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    © All Rights Reserved
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    54 views1 page

    Parents Mental Health Survey

    Uploaded by

    Emelyn Manahan Salvador
    The document is a parent mental health survey form from Burgos National High School. It includes a note from the counselor explaining that the guidance and counseling office wants to conduct a survey to better understand how parents are feeling about themselves, others, and difficult situations. The form asks parents to provide contact information and then rate how 21 statements about feelings of anxiety, stress, sadness, and worry apply to them over the past few days. The ratings are on a scale from 0 to 3 indicating how often each statement applies.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Burgos National High School Main

    Parent’s Mental Health Survey Form


    Note from the Counselor

    Dear Parent/s! GCO – DPC

    The Guidance and Counseling Office is taking a Accomplishing the identifying information and
    proactive response to reduce the aftermath of Mental submitting the form attest that you have read and
    Health crisis.  With this, we wanted to conduct a understood the Data Privacy and Consent Notice of
    survey that will give us a comprehensive the Guidance and Counseling Office (GCO). This also
    understanding of how you feel towards yourself, signifies that you express your consent for the GCO
    others and significant situations you encounter in your personnel to collect, record, organize, update, modify,
    journey as a parent. That is why, again, may I ask for consult, use consolidate, block, erase your personal
    your honest cooperation in this activity. Thank you data as part of my information.
    and God bless!

    Your Counselor

    Part 1
    Direction: Please fill out this form by writing your
    personal information on each blank. QUESTIONS 0 1 2 3
    1. Nahihirapan akong magrelax kapag
    may problema
    Name: ____________________________________
    2. Nanunuyo ang aking lalamunan
    Age: ____________ Male/Female: ___________ 3. Hindi ako nakakaranas ng positibong
    Grade & Section of child: ____________________ damdamin o paikiramdam
    4. Nakakaranas ako ng hirap sa paghinga
    Facebook Name: ___________________________
    5. Nahihirapan
    Contact No.: ______________________________ akong simulan ang mga gawain
    Person to be contacted 6. Madali akong maapektuhan ng mga
    sitwasyon
    in case of emergency: _______________________ 7. Nakaranas ako ng panginginig ng
    Contact No. of Contact kamay
    8. Madalas akong kinakabahan o nag-
    Person:_______________________ aalala
    9. Nag-aalala ako kapag ako ay nasa
    Part 2 mga sitwasyon na nakakataranta
    10. Pakiramdam ko wala akong aasahan
    Direction: Please read each statement on the right side of sa kinabukasan ko
    this paper and CHECK a number 0, 1, 2 or 3 which indicates 11. Madali akong kabahan
    how much the statements applied to you over the past 12.Nahihirapan akong ikampante ang
    days. There are no right or wrong answer. Do not spend too sarilli ko
    much time on any statement. 13. Nakaramdam ako ng kalungkutan at
    kawalan ng pag-asa
    14. Hindi ako pumapayag na may
    The rating scale is as follows: sumagabal sa mga ginagawa ko
    15. Madalas akong mataranta
    0 - Did not apply to me at all - NEVER 16. Hindi ako nakakaramdam ng saya sa
    1 - Applied to me to some degree, or some of the time kahit anong bagay
    - SOMETIMES 17. Pakiramdam ko wala akong halaga
    2 - Applied  to me to a considerable degree, or a good 18. Madali akong mairita
    part of time - OFTEN 19. Minsan hindi normal ang pagtibok
    3 - Applied to me very much , or most of the time- ng puso ko
    ALMOST ALWAYS 20. Natatakot ako nang walang dahilan
    21. Pakiramdam ko walang kahulugan
    ang buhay

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