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Rose-Mary Reynolds
Questionnaire
My name is Rose-Mary Reynolds and I am a second year Caribbean Studies student. My Internal
Assessment requires me to distribute questionnaires in order to determine the effect of a fathers
absence on an adolescents self-esteem among the students at Antigua State College. Please
place an X in the box provided and do not place your name on this questionnaire as it is to
remain anonymous. Thank you for your participation in this questionnaire as your honesty is
greatly valued and appreciated.
.
1. Personal Details
a. Gender:
Male
b. Age:
15-16
Female
17-18
c. Family type:
Single mother family
Nuclear family
d. Department:
A level
19-20
21 and over
Visiting Union
Extended family
Engineering
Other: __________________
Commercial
2. On a scale of 1-5, 1 being the best and 5 being the worst, how would you rate your selfesteem?
1
2
3
4
5
If you are in a single mother family, answer questions 3-6
3. How long have you been living in a household without your father?
Less than a year
More than 5 years
1 5 years
Rose-Mary Reynolds
Abandonment
Other: ____________________________
Rose-Mary Reynolds
14. Give a reason for your answer above
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
15. Rate the options on a scale of 1-3 to which you think what factors are more prevalent in
impacting a teens self-esteem?
___ Body Image
___ Social Experiences
___ Academic performance
___ Approval by peers
___ Media
16. What do you think can be done to solve adolescents with self-esteem issues?
Therapy/counselling
Having healthier motivational thoughts
Self-appreciation exercises/seminars
Education on the issue within schools and public