Republic of the Philippines

Department of Education
Region XII
Division of Sultan Kudarat
ISULAN NATIONAL HIGH SCHOOL
School ID:304590
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“Questionnaire about How Broken family Effect the student’s”

NAME:___________________ (Optional) SEX:_________

GRADE & SECTION: ________________ AGE:_______(Please Specify)

Directions: Below are the items about the effects of having a broken family to the student Academic
Performance, Attitude and Social Status.
Please put a check (✓) and rate your answer Honestly, based on the question giving us the following
scale.

5-Always 4-Often 3-Sometimes 4- Rarely 1-Never

QUESTIONNAIRE ABOUT HOW BROKEN FAMILY AFFECT THE STUDENT ACADEMIC PERFORMANCE,
ATTITUDE AND SOCIAL STATUS

Academic Performance Question 5 4 3 2 1

1.Do your parents monitor your progress in school?
2.Does being part of a broken family inspire you for your future?
3.Is having yourself inspires you to do Academic Activities?
4.Do you perform properly in your written outputs, and
Performance task in your school?
Attitude (Peer) Question
1.Do you bullied by the others because of having a broken family?
2.Do you usually socialize with the others?
3.Do you share your problems with your friends?
4.Do you feel left out by your classmates?
Attitude (Parents) Question
1.Does your family situation inspired you?
2.Do your parents support you for every decision?
3.We’re have any circumstances do you decide to live your own?
Attitude (Teacher) Question
1.Do you share your problems with your teacher?
2.Do you feel uncomfortable in class because of having a broken
family?
3.Do your teacher care your progress in school
4.Do your teacher support you?
Social Status Question
1.Do your parents pay your school fees at time?
2. Do your Parents provide you enough money for your studies?
3.Did your family provide you financially?
4.Did you have a complete meal everyday?

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Student Signature