APPENDICES

A. Letter of Request
B. Draft of Research Made Instrument (Research- made Questionnaire)

I. Profile of the Respondents

Complete survey items/interview questions/guide question/list of data to be collected: (choose

which is applicable)

Name (optional):______________________________________________

1. Sex (at birth):

Male

female

2. Current Age:

18

19

20

21

22

23

24

25
 3. Year level:

First year

Second year

Third year

Fourth year

4. Department/college:

CAS

CABE

CIT

CICS

CTE

PART II. Instruction: Please read each statement and circle a number 4, 3, 2 or 1 which

indicates how much the statement applied to you. There are no right or wrong answers. Please

indicate a check (/) to the scale that corresponds to your answer.The rating scale is as follows:

.Likert Scale Frequency: Always – Sometimes – Rarely – Never

4 - Always

3 - Sometimes

2 - Rarely

1 - Never
 A. Communication Gap 4 3 (Sometimes) 2 1

(Always) (Rarely) (Never)

Because of my parents' separation…

1. I become more comfortable discussing my

problem with my peers rather than to

them.

2. I distanced myself to them to lessen the

pain they brought me when they separated.

3. I prefer being silent most of the time to

avoid having interaction with them.

4. I cannot express myself well for the fear of

being misunderstood.

5. It makes me anxious when talking about

family matters.

6. It is so hard for me to open my mouth and

tell them what I feel.

 7. I don't want to open up with my parents

because of what happened.

8. I became more comfortable when I’m

around with other relatives on my father's

side.

9. I become more comfortable when I’m

around with other relatives on my mother's

side.

10. I feel more at ease not seeing them

personally rather than talking with them.

B. Academics

Because of my parents separation…

1. It deteriorates my academic performance.

2. I tend to have difficulty concentrating in

my studies.
 3. I tend to always have failing grades.

4. I became less attentive in class.

5. I have lost interest in studying.

6. I cannot cope up with the lessons quickly.

7. I rarely passed the examination.

8. I don’t have the urge to raise my hand

every time there is a recitation.

9. I am having trouble answering my school

work at home.

10. Every time there is a group activity, I

would rather work alone than in a group.

C. Self esteem

Because of my parents separation…

1. I build a sense of independence.

2. I feel that I don’t have so much to be

proud of.

3. I learned how to cope up with stress

effectively.

4. I try to hide my feelings to other people

when talking about family matters.

5. I tend to compare myself with others.

6. I felt ashamed to share about my family

situation.

7. On the whole, I am satisfied with myself.

8. I feel that I'm a person of worth, at least on

an equal plane with others.

9. I take a positive attitude toward myself.

10. I certainly feel useless at times.

D. Socialization

Because of my parents separation…

1. I always feel uncomfortable when

someone approaches me.

2. I have poor attachment with peers.

3. I always stutter every time I speak in front

of many people.

4. I tend to stay at home rather than

socializing.

5. I like to spend my free time with other

people.

6. I prefer having an original value structure

rather than being part of a group.

7. I prefer helping other people instead of

arguing in public.
 8. I easily communicate with the other

members of the society.

9. I like to meet new people, and get

engaged in social activities.

10. I prefer to stay away from the crowds as

much as possible.

INTERVIEW QUESTIONS

1. What is your name? (Ano ang iyong pangalan?).

2. How are you now? (Kumusta ka naman ngayon?).

3. How many of you are siblings? (Ilan kayong magkakapatid?).

4. How many years did your parents separate? (Ilang taon na hiwalay ang iyong

magulang?).

5. In what way did your parents get separated? Specify. (Sa anong paraan naghiwalay ang

iyong magulang?).

6. What kind of separation did your family have and when did your parents separated?

(Paano ang naging lagay ng pamilya mo noong naghiwalay ang magulang mo?).

7. Can you give some reasons why your parents separated? You can discharge or disagree to

answer in this question if your not comfortable.(Puwede ba namin malaman kung anong
 rason ng separation ng iyong magulang? Maaari kang tumanggi kung hindi mo gusto

sagutin ang tanong na ito).

8. What are your coping mechanisms to this kind of situation of yours? (Anong mga paraan

ang iyong ginawa upang malampasan ang ganitong klaseng pagsubok?).

9. What can you consider as positive and negative impact of parents separation in your life?

(Para sayo ano ang mga positibo at negatibong epekto ng hiwalay na magulang sa iyong

buhay?).

10. Can you give a message and any advice to the people who are also experiencing it?

(Maaari ka bang magbigay ng mensahe o payo sa mga taong nakakaranas din ng broken

family?).