The Impact of Family Conflict to the Academic

Performance of 25 Junior High School Students

Instruction : Please supply all required information

NAME :_____________________ AGE:__________

GRADE LEVEL:__________ GENDER: _______

Instructions: Indicate your answer by putting a check mark (√) on the box or appropriate
column.Please be guided with the following scale below:

RATING SCALE:

5 – Always (A) 4 – Often (O) 3 – Sometimes (S) 2 – Rarely (R) 1 – Never (N)

5 4 3 2 1
Always (A) Often (O) Sometimes (S) Rarely (R) Never (N)

1. Have you ever missed school or class due

to family conflicts?

2. Have you ever considered changing schools or

educational environments due to the impact of family
conflicts on your academic performance?

Do you often fight with your parents?

3.

4. Do you go to school without enough allowance due to

financial problems?

How often have you missed class, homework

5.
assignments,
to or other academic-related activities due
family conflict?

6. Have you ever experienced any discrimination or

mistreatment at school due to family conflicts or other
personal struggles?

7. Do your teachers seem approachable when it comes to

discussing family conflicts and their impact on your
academic performance?
8. Do family conflicts affect your motivation to excel
academically?

Open-ended questions:
1. Are there any specific family conflicts that you feel have had a greater impact on your academic performance?

. 2. Do you ever feel like family conflicts put too much pressure on you, which affects your ability to focus on school?