Sample A: Cover Page of Thesis, Project, or Dissertation Proposal

Appendix D
PARENT QUESTIONNAIRE
Name: ___________________________________________
Subject # ______________________________________
Please circle the emotion you think your child would be most likely to display in the
following situations: (If you have not seen a situation, try to predict what your child
would feel.)
1. Coming to preschool. Happy Sad
2. Going to the airport, seeing the airplane, etc., but also seeing a parent off on a trip.
Happy Sad
3. What is your child‘s favorite food, which makes him/her very happy? ____________
Least favorite ___________
4. Coming in from playing outside when you call him/her for dinner.
Happy Angry
5. Seeing a big although friendly dog. Happy Afraid
6. Going into the water at the swimming pool. Happy Afraid
7. Some other kids would not let him/her play. Angry Sad
8. He/she is told that he/she has to stay home while everyone else in the family goes to
get ice cream. Angry Sad
9. A brother or sister punches him/her, and says that if he/she tells Mom or dad, they
will hit him/her again. Angry Afraid
10. Getting a spanking. Angry Afraid
11. After doing something naughty, a parent says if they do it again, they will have to be
punished. Sad Afraid
12. Experiencing the death of a fairly close friend or member of the extended family.
Sad Afraid
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