Vark
B O X 6 – 1 Heritage Assessment Tool
Note: The greater the number of positive responses, the greater the person’s identification with a traditional heritage. The one exception to positive answers is the question about family name change. This question may be answered negatively.
1. Where was your mother born? __INDIA__________________________
2. Where was your father born? _INDIA_____________________________
3. Where were your grandparents born?
(1) Your mother’s mother? _____INDIA_________________________
(2) Your mother’s father? _INDIA_____________________________
(3) Your father’s mother? __INDIA____________________________
(4) Your father’s father? _INDIA_______________________________
4. How many brothers __0___ and sisters ___1__ do you have?
5. What setting did you grow up in? Urban _____ Rural _*_____ Suburban _____
6. What country did your parents grow up in?
Father _INDIA____
Mother __INDIA___
7. How old were you when you came to the United States? ___21__
8. How old were your parents when they came to the United States? Mother __50___ Father __51___
9. When you were growing up, who lived with you? _PARENTS____
10. Have you maintained contact with
a. Aunts, uncles, cousins? (1) Yes __YES___ (2) No _____
b. Brothers and sisters? (1) Yes __YES___ (2) No _____
c. Parents? (1) Yes ___YES__ (2) No _____
d. Your own children? (1) Yes ___YES__ (2) No _____
11. Did most of your aunts, uncles, cousins live near your home?
(1) Yes _____ (2) No __NO___
12. Approximately how often did you visit your family members who lived outside your home?
(1) Daily _____ (2) Weekly _____ (3) Monthly *_____ (4) Once a year or less _____ (5) Never _____
13. Was your original family name changed?
(1) Yes _____ (2) No __*___
14. What is your religious preference?
(1) Catholic __christian___ (2) Jewish _____ (3) Protestant _____
(4) Denomination (5) Other _____ (6) None _____
15. Is your spouse the same religion as you?
(1) Yes ___yes__ (2) No _____
16. Is your spouse the same
Note: The greater the number of positive responses, the greater the person’s identification with a traditional heritage. The one exception to positive answers is the question about family name change. This question may be answered negatively.
1. Where was your mother born? __INDIA__________________________
2. Where was your father born? _INDIA_____________________________
3. Where were your grandparents born?
(1) Your mother’s mother? _____INDIA_________________________
(2) Your mother’s father? _INDIA_____________________________
(3) Your father’s mother? __INDIA____________________________
(4) Your father’s father? _INDIA_______________________________
4. How many brothers __0___ and sisters ___1__ do you have?
5. What setting did you grow up in? Urban _____ Rural _*_____ Suburban _____
6. What country did your parents grow up in?
Father _INDIA____
Mother __INDIA___
7. How old were you when you came to the United States? ___21__
8. How old were your parents when they came to the United States? Mother __50___ Father __51___
9. When you were growing up, who lived with you? _PARENTS____
10. Have you maintained contact with
a. Aunts, uncles, cousins? (1) Yes __YES___ (2) No _____
b. Brothers and sisters? (1) Yes __YES___ (2) No _____
c. Parents? (1) Yes ___YES__ (2) No _____
d. Your own children? (1) Yes ___YES__ (2) No _____
11. Did most of your aunts, uncles, cousins live near your home?
(1) Yes _____ (2) No __NO___
12. Approximately how often did you visit your family members who lived outside your home?
(1) Daily _____ (2) Weekly _____ (3) Monthly *_____ (4) Once a year or less _____ (5) Never _____
13. Was your original family name changed?
(1) Yes _____ (2) No __*___
14. What is your religious preference?
(1) Catholic __christian___ (2) Jewish _____ (3) Protestant _____
(4) Denomination (5) Other _____ (6) None _____
15. Is your spouse the same religion as you?
(1) Yes ___yes__ (2) No _____
16. Is your spouse the same