Questionnaire

METRO MANILA COLLEGE GRADUATE SCHOOL 1
QUESTIONNAIRE
Dear Respondents:
The undersigned is conducting a research entitled, “Family Breakup and Its Impact
on Student Development”, and requesting your full cooperation to please answer the
questions with honesty and accuracy to be able to come up with valid and reliable
result. Your utmost cooperation will be highly appreciated by your truly.
Thank you very much and God bless.
Very truly yours,
CHARLENE O. TORREJOS
Researcher
Name: ___________________________ (optional)
1. Profile of the respondents
Direction: Please check the corresponding response on the indicators provided as to

profile of the respondents:
1.1 Sex
____ Male
____ Female
1.2 Age when parents broke up
_____ 0-5 years old
_____ 6-10 years old
_____ 10-15 years old
_____ 16 and above
1.3 Birth Order

_____ 1st child
_____ 2nd child
_____ 3rd child
_____ 4th child
_____ 5th child
_____ 6th up
1.4 Guardianship (Person you are living with)
_____ Mother
_____ Father
_____ Relative
_____ Non- Relative
2. Read each statement carefully and rate the following development according
to your level of agreement on the possible descriptions of your emotional
behavior, social development, and academic performance. Use the following
scale for your reference:
4 – Strongly Agree (SA)
3 – Agree (A)
2 – Disagree (D)
1 – Strongly Disagree (SD)
2.1 Emotional Behavior

Indicators 4 3 2 1
(SA) (A) (D) (SD)
1. Have deeper capacity for caring
and sharing.
2. Feels a lot of mood changes or
mood swings.
3. Feels terrified of the realities of
pending adulthood.
4. Take fewer risks.
5. Think friends are more
important than family.
6. Can hardly trust people.
2.2 Social Development

Indicators 4 3 2 1
(SA) (A) (D) (SD)
1. Exhibit more independence
from parents/guardians and
spends more time with friends.
2. Show interest in romantic
relationships, intimacy, and
sexuality.
3. Concern about physical
development and look for social
acceptance.
4. Show sign of confidence and
increased resistance to peer
pressure.
5. Able to make and keep
commitments.
6. Dependent on peers.
2.3 Academic Performance

Indicators 4 3 2 1
(SA) (A) (D) (SD)
1. Exhibits more concern about
future school, work plans and
work habits.
2. Able to rationalize my own
choices, including what is right or
wrong.
3. Changes language and
behaviors between school, home,
and other settings.
4. Aspire for recognition and
applause in the classroom from
teachers and classmates.
5. Able to cope with the academic
pressures.
6. Longing for academic support
from parents.
3. Read each statement carefully and rate the following effect of family breakup
according to the extent that describes your emotional behavior, social development,
and academic performance. Use the following scale for your reference:
4-Very High Extent (VHE), 3-High Extent (HE), 2-Low Extent (LE), 1-Very
Low Extent (VLE).
Indicators 4 3 2 1
(VHE) (HE) (LE) (VLE)
Emotional Behavior
1. There is a feeling of insecurity
and rejection.
2. There is a feeling of guilt
about having caused the parental
separation.
3. There is a sense of loss, a
feeling of not just losing my
parents but also my whole life.
4. There is fear of being left
alone, that is, if one of my
parents left, perhaps the other
one can do it as well.
5. There is hatred; I am angry at
my parent (or both parents) who
caused the relationship
breakdown.
6. I am more mature in dealing
with problems.
Indicators 4 3 2 1
(VHE) (HE) (LE) (VLE)
Social Development
1. I vent my distress about my
family by acting aggressive and
by engaging in bullying.
2. I experience anxiety which
made me shy away from people I
am not friends with.
3. I became very cautious about
relationships. It is hard for me to
trust the opposite sex.
4. My friends give me a sense of
belongingness; I don’t like
staying anymore in our house.
5. I only go for superficial
relationships and I am willing to
give it up soon as problems arise.
6. I am independent in my
actions and words.
Academic Performance
1. I can’t go to school regularly
because of inadequate financial
resources.
2. I became less involved with
school, responsibilities, and other
activities since my parents can’t
anymore come to school
together.
3. I cannot anymore concentrate
inside the classroom; I am
bothered by what happened.
4. I wanted to start in a new
school where my classmates
would not have any idea of my
parents’ breakup.
5. I am less determined to study
hard for that could not lead to
my parents’ reconciliation.
6. I am challenged to perform
better because of our family
situation.
Thank you!

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METRO MANILA COLLEGE GRADUATE SCHOOL 1

Thank you very much and God bless.

Very truly yours,

Name: ___________________________ (optional)

1. Profile of the respondents

Direction: Please check the corresponding response on the indicators provided as to

1.3 Birth Order

2.1 Emotional Behavior

2.2 Social Development

2.3 Academic Performance

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