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QUESTIONNAIRE
QUESTIONNAIRE
QUESTIONNAIRE
Gender: ( ) Male
( ) Female
Age:
( ) 12-13 years old
( ) 14-16 years old
( ) 17 years old and above
Grade Level:
( ) Grade 7 ( ) Grade 10
( ) Grade 8 ( ) Grade 11
( ) Grade 9 ( ) Grade 12
INDICATORS 5 4 3 2 1
1. My quarterly grades and average are declining.
2. I am not interested in coming to school and in studying.
3. I often feel unhappy, depressed or tearful.
4. I envy my classmates during family day or activities.
5. I pay my tuition fee or school fees in delay.
6. I do not have someone to listen or to share my problems in
school.
7. Doing assignment is hard for me.
8. I feel nervous or clingy in new situations and easily loses
confidence.
9. I involve to any troubles and gets disciplinary action.
10. I have many worries or often seem worried about my studies.
11. I take all the responsibilities in taking charge of my siblings at
school.
12. I do all the responsibilities at home that often resulted for my
absences.