Professional Documents
Culture Documents
I.PROFILE
• GRADE:________ •STRAND OR SECTION: ____________ •GENDER:_____
•AGE:______ • RELIGION AFFILIATION (e.g Catholic, I.N.C, e.t.c):________
II. QUESTIONS
•MENTAL DISORDER IMPACT
DIRECTIONS: Encircle the letter of your chosen answer.
1. Does depression or anxiety affect the way you do your schoolwork’s?
A. Highly affected
B. Affected
C. Possibly affected
D. Littler affected
E. Not affected
2. In a scale of 1 to 5, how bad does your mental illness influence you as a learner.
A. 1 (not bad)
B. 2 (solely bad)
C. 3 (slightly bad)
D. 4 (bad)
E. 5 (extremely bad)
3. Do You think like you’re a burden to your family or to your own self?
A. All the time
B. Regularly
C. Slightly
D. Rarely
E. Never
•SCALING MENTALITY
DIRECTIONS: Check the three table below concerning your mental illness, put a check in the column
which truly fits your choice. There are 1-5 scales in the following:
HIGHLY AFFECTED - 5
AFFECTED - 4
POSSIBLY AFFECTED - 3
FAINTLY AFFECTED - 2
NOT AFFECTED – 1
I. ACADEMIC PERFORMANCE 1 2 3 4 5