Free Heritage Assessment Tool Creative Writing Example

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.

Indian family

1. Where was your mother born? __________ Delhi__________________
2. Where was your father born? ___________Mumbai ___________________
3. Where were your grandparents born?
(1) Your mother’s mother? _____________ Delhi _________________
(2) Your mother’s father? _______________ Delhi _______________
(3) Your father’s mother? _______________ Mumbai _______________
(4) Your father’s father? _________________ Mumbai _______________
4. How many brothers __1___ and sisters __3___ do you have?
5. What setting did you grow up in? Urban __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? __10___
8. How old were your parents when they came to the United States? Mother __32___ Father _36____
9. When you were growing up, who lived with you? __my family and my cousin___
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 __yes___ (3) Monthly _____ (4) Once
a year or less _____ (5) Never __ ___
13. Was your original family name changed?
(1) Yes __yes___ (2) No _____
14. What is your religious preference?
(1) Catholic _____ (2) Jewish _____ (3) Protestant _____
(4) Denomination (5) Other _Buddhism____ (6) None _____
15. Is your spouse the same religion as you?
(1) Yes __yes___ (2) No _____
16. Is your spouse the same ethnic background as you?
(1) Yes __yes___ (2) No _____
17. What kind of school did you go to?
(1) Public _____ (2) Private _yes____ (3) Parochial _____
18. As an adult, do you live in a neighborhood where the neighbors are the same religion and ethnic background as yourself?
(1) Yes _____ (2) No _no____
19. Do you belong to a religious institution?
(1) Yes __yes___ (2) No _____
20. Would you describe yourself as an active member?
(1) Yes ___yes__ (2) No _____
21. How often do you attend your religious institution?
(1) More than once a week _____ (2) Weekly _____
(3) Monthly __yes___ (4) Special holidays only _____
(5) Never _____
22. Do you practice your religion at home?
(1) Yes _yes____ (2) No _____
(If yes, please specify)
(3) Praying __yes___ (4) Bible reading _____
(5) Diet _____ (6) Celebrating religious holidays _____
23. Do you prepare foods of your ethnic background?
(1) Yes __yes___ (2) No _____
24. Do you participate in ethnic activities?
(1) Yes __yes___ (2) No _____
(If yes, please verify)
(3) Singing _____ (4) Holiday celebrations _____
(5) Dancing _____ (6) Festivals __ yes___
(7) Costumes __yes___ (8) Other _____
25. Are your friends from the same religious background as you?
(1) Yes __yes___ (2) No _____
26. Are your friends from the same ethnic background as you?
(1) Yes __yes___ (2) No _____
27. What is your native language? __Indian___
28. Do you speak this language?
(1) Prefer __ speak while at home with the family___ (2) Occasionally _____ (3) Rarely _____
29. Do you read your native language?
(1) Yes __yes___ (2) No _____

Chinese family

1. Where was your mother born? _________ Beijing___________________
2. Where was your father born? ___________ Beijing ___________________
3. Where were your grandparents born?
(1) Your mother’s mother? ________________ Beijing ______________
(2) Your mother’s father? _________________ Beijing _____________
(3) Your father’s mother? ______________________________
(4) Your father’s father? ________________ Beijing ________________
4. How many brothers _1____ and sisters __none___ do you have?
5. What setting did you grow up in? Urban __urban___ Rural _____

Suburban _____

6. What country did your parents grow up in?

Father __china___

Mother __china___
7. How old were you when you came to the United States? __2___
8. How old were your parents when they came to the United States? Mother __25___ Father __31___
9. When you were growing up, who lived with you? __my parent and brother___
10. Have you maintained contact with?
a. Aunts, uncles, cousins? (1) Yes _____ (2) No __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 __yes___ (3) Monthly _____ (4) Once a year or less _____ (5) Never _____
13. Was your original family name changed?
(1) Yes __yes___ (2) No _____
14. What is your religious preference?
(1) Catholic _____ (2) Jewish _____ (3) Protestant _yes____
(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 ethnic background as you?
(1) Yes _____ (2) No __no___
17. What kind of school did you go to?
(1) Public __yes___ (2) Private _____ (3) Parochial _____
18. As an adult, do you live in a neighborhood where the neighbors are the same religion and ethnic background as yourself?
(1) Yes _____ (2) No __no___
19. Do you belong to a religious institution?
(1) Yes __yes___ (2) No _____
20. Would you describe yourself as an active member?
(1) Yes __yes___ (2) No _____
21. How often do you attend your religious institution?
(1) More than once a week _____ (2) Weekly _yes____
(3) Monthly _____ (4) Special holidays only _____
(5) Never _____
22. Do you practice your religion at home?
(1) Yes _yes____ (2) No _____
(If yes, please specify)
(3) Praying __yes___ (4) Bible reading _____
(5) Diet _____ (6) Celebrating religious holidays _____
23. Do you prepare foods of your ethnic background?
(1) Yes _____ (2) No __yes___
24. Do you participate in ethnic activities?
(1) Yes _____ (2) No __yes___
(If yes, please verify)
(3) Singing _____ (4) Holiday celebrations _____
(5) Dancing _____ (6) Festivals __yes___
(7) Costumes _____ (8) Other _____
25. Are your friends from the same religious background as you?
(1) Yes __yes___ (2) No _____
26. Are your friends from the same ethnic background as you?
(1) Yes ___yes__ (2) No _____
27. What is your native language? __Chinese___
28. Do you speak this language?
(1) Prefer _____ (2) Occasionally _____ (3) Rarely _yes____
29. Do you read your native language?
(1) Yes _____ (2) No __no___

Hispanic family

1. Where was your mother born? ______ Mexico city______________________
2. Where was your father born? ______Mexico city________________________
3. Where were your grandparents born?
(1) Your mother’s mother? ________ Mexico city______________________
(2) Your mother’s father? _________ Mexico City _____________________
(3) Your father’s mother? __________ Puebla____________________
(4) Your father’s father? _____________ Puebla ___________________
4. How many brothers __2___ and sisters __1___ do you have?
5. What setting did you grow up in? Urban __urban___ Rural _____

Suburban _____

6. What country did your parents grow up in?

Father __United State___

Mother ___ United State __
7. How old were you when you came to the United States? __I was born in the United State ___
8. How old were your parents when they came to the United States? Mother __20___ Father _12____
9. When you were growing up, who lived with you? __My parents and siblings___
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 __yes___ (4) Once a year or less _____ (5) Never _____
13. Was your original family name changed?
(1) Yes _____ (2) No _no____
14. What is your religious preference?
(1) Catholic _yes____ (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 ethnic background as you?
(1) Yes __yes___ (2) No _____
17. What kind of school did you go to?
(1) Public _yes____ (2) Private _____ (3) Parochial _____
18. As an adult, do you live in a neighborhood where the neighbors are the same religion and ethnic background as yourself?
(1) Yes __yes___ (2) No _____
19. Do you belong to a religious institution?
(1) Yes __yes___ (2) No _____
20. Would you describe yourself as an active member?
(1) Yes _yes____ (2) No _____
21. How often do you attend your religious institution?
(1) More than once a week _____ (2) Weekly __yes___
(3) Monthly _____ (4) Special holidays only _____
(5) Never _____
22. Do you practice your religion at home?
(1) Yes __yes___ (2) No _____
(If yes, please specify)
(3) Praying __praying___ (4) Bible reading __yes___
(5) Diet _____ (6) Celebrating religious holidays _yes___
23. Do you prepare foods of your ethnic background?
(1) Yes __yes___ (2) No _____
24. Do you participate in ethnic activities?
(1) Yes __yes___ (2) No _____
(If yes, please verify)
(3) Singing _____ (4) Holiday celebrations _____
(5) Dancing __yes___ (6) Festivals _yes____
(7) Costumes _____ (8) Other _____
25. Are your friends from the same religious background as you?
(1) Yes _____ (2) No _I have variety of friends____
26. Are your friends from the same ethnic background as you?
(1) Yes _____ (2) No ___no__ I have variety of friend
27. What is your native language? __Spanish___
28. Do you speak this language?
(1) Prefer _____ (2) Occasionally __yes___ (3) Rarely _____
29. Do you read your native language?
(1) Yes _____ (2) No _no____