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.
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
1. I feel down, depressed, or hopeless in the middle of doing school works.
2. I am failing a lot of subjects recently.
3. I have little or no interest in participating to school activities.