MALINDIG INSTITUTE FOUNDATION INC. MALINDIG INSTITUTE FOUNDATION INC.

PRACTICAL RESEARCH 2 PRACTICAL RESEARCH 2

“The Effects of Broken Homes to the Senior High School Students and to their
Academic Performance in Santa Cruz, Marinduque.”

1.1:Please check the following statements 3. ACADEMIC PERFORMANCE (5) (4) (3) (2) (1)
Strongly Agree Neutral Disagree Strongly
1. DEMOGRAPHIC INFORMATION Agree Disagree
1. I Perfect my Quizzes
Name(Optional):______________________________
2. I Complete my Attendance
A. Age: __15 __16 __17 __18 __19 other, please specified:___
3. I Making my Assignments
B. Grade: ___11 ___12
4. I Participate in Recitation
C. Gender: ___Male ___Female
5. I am Doing my Class
D. What is your family Structure as a broken homes? Project
___Divorced ___Separated ___Death of a Parent ___Absence of a Parent.

Extra: Do you believe that this study can made a significant contribution?
Directions 1.2: For each statement in the survey, please indicate how much you Agree or
Disagree with the statement by putting a check in the box on the right side of each ____(YES) ____(NO)
statement. There are no right or wrong answers. Your answer will kept strictly confidential and
you will not be identified.

5-Strongly Agree (Indicates that the characteristic is always manifested) Please: if you have any suggestions or ideas that can help us to develop to mitigate or
4-Agree (Indicates that the characteristic is often manifested) prevent this issue please let us know:
3-Neutral (Indicates that the characteristic is sometimes manifested)
2-Disagree (Indicates that the characteristic is seldom manifested) _______________________________________________________________________
1-Strongly Disagree (Indicates that the characteristic is never manifested) _______________________________________________________________________
_______________________________________________________________________
2. SENIOR HIGH SCHOOL (5) (4) (3) (2) (1) _______________________________________________________________________
STUDENTS Strongly Agree Neutral Disagree Strongly _______________________________________________________________________
Agree
Disagree
1.) I received Emotional Support from
my parents. Disclaimer:
2.) I received financial support from I have read and understood all the information give by the Researcher’s. My
my Parents. Participation in this Survey is Voluntary and my Willingness to give Insights and
3.) I received Educational Support Information for the survey.
from my parents.
4.) I received Moral Support from my
Parents.
5.) I received social Support from my _________________
family members. __________________________________
Date. Signature of the Respondent
 MALINDIG INSTITUTE FOUNDATION INC. MALINDIG INSTITUTE FOUNDATION INC.

PRACTICAL RESEARCH 2 PRACTICAL RESEARCH 2

“WAIVER”

This waiver will be use as evidence that the respondents of this study is telling the truth by
the confirmation of their (parents/guardians)(teacher/adviser) who knows their personal
background and academic performance.

For the Parent/Guardian For the Teacher/Adviser

I am ___________________,the(parents)(guardian)______________of I am ___________________, the(Teacher)(Adviser)______________of

_____________________, Agreeing that my__________, is telling the truth, about his/her _____________________, Agreeing that my__________, is telling the truth, about his/her
answer on the survey questionnaire that provided because I know him/her personal answer on the survey questionnaire that provided because I know him/her academic
background. performance.

I also aware that this waiver will be use as the evidence to prove that his/her answered on I also aware that this waiver will be use as the evidence to prove that his/her answered on
the survey questionnaire are true, as provided by the Researcher’s. the survey questionnaire are true, as provided by the Researcher’s.

________________ ________________
Parent/Guardian Teacher/Adviser

Signature with printed name Signature with printed name

Thank you for your participation!, we very appreciate your contribution. Thank you for your participation!, we very appreciate your contribution.