What is your age? What is your gender? What is your current year level (e.g.

high school, college, etc.)?

1. Do you think that a supportive home environment can help students reach their academic goals?

a. Yes

b. No

c. Not sure

2. How would you rate your current academic performance?

a. Very good

b. Good

c. Average

d. Poor

e. Very poor

3. How would you rate the quality of your home environment?

a. Very good

b. Good

c. Average

d. Poor

e. Very poor

4. How would you rate the impact of your home environment on your motivation to perform well
academically?

a. Very positive

b. Positive

c. Neutral

d. Negative

e. Very negative
5. How often do you receive support from your family in terms of academic performance?

a. Always

b. Often

c. Sometimes

d. Rarely

e. Never

6. How often do you feel encouraged by your family to pursue academic excellence?

a. Always

b. Often

c. Sometimes

d. Rarely

e. Never

7. How often do you feel that your home environment is motivating you to do your best academically?

a. Always

b. Often

c. Sometimes

d. Rarely

e. Never

8. How much do you feel that your home environment has an impact on your academic performance?

a. A great deal

b. Quite a bit
c. A moderate amount

d. A little bit

e. Not at all

9. Do you feel that your home environment provides you with the necessary resources to help you
succeed academically?

a. Yes

b. No

c. Not sure

10. Do you feel that your home environment encourages you to take on challenging tasks and strive for
excellence in your academic performance?

a. Yes

b. No

c. Not sure

11. Do you feel that your home environment provides you with a supportive and nurturing environment
to help you succeed academically?

a. Yes

b. No

c. Not sure

12. Do you feel that your home environment provides you with the necessary resources and support to
help you achieve your academic goals?

a. Yes

b. No
c. Not sure

13. Do you feel that your home environment provides you with the necessary guidance and advice to
help you make the best decisions for your academic success?

a. Yes

b. No

c. Not sure

14. Do you feel that your home environment provides you with the necessary encouragement and
motivation to help you stay focused and motivated in your academic pursuits?

a. Yes

b. No

c. Not sure

15. Do you feel that your home environment provides you with the necessary structure and discipline to
help you stay on track and achieve your academic goals?

a. Yes

b. No

c. Not sure