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Part 1.

Personal Data Sheet


Please provide the information asked for in each item by writing the corresponding answers on the space
provided.
Name(optional)_____________________________ Age_______ Gender___________
Part 2. Read the following statements and check the column that corresponds to how you feel about each of
the items.

RESPONSE
Strongly Strongly
ITEMS Disagree
Disagree Uncertain Agree
Agree

1. I enjoy spending holidays with my family.

2. I usually spend my time in my friend’s house.

3. I enjoy doing household chores with my family.

4. I want to hang out with my friends all the time.

5. I eat meals together with my family.

6. I tell my parents if I have problems.

7. I show my affection to my family.

8. I spend the weekends with my friends rather than my


family.

9. I spend the most of my time talking on social media


with my friends.

10. I tend to share my problems with my friends more


than with my family.

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