FORMS_RACIAL IDENTITY QUESTIONNAIRE

RACIAL IDENTITY QUESTIONNAIRE

Name of Organization

DEMOGRAPHIC QUESTIONS -

Your Age

Your Gender

Your Race

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Take the time to answer the following question.

Honestly look at your life influences (through a racialized filter). What comes out the other side is how these influences have affected you.

Framing Question: How do I feel about Racism?

FAMILY INFLUENCES -

What were my parents' attitudes towards Racism?

What about my other relatives' attitudes towards Racism?

What were my parents' or guardians' behaviors towards Racism?

What were my other relatives' behaviors towards Racism?

PERSONAL EXPERIENCE -

Did I know any persons of a different race growing up?

Did I experience any negative views towards persons of a different race growing up?

Did I have any personal experiences + or – with persons of a different race growing up?

EDUCATIONAL EXPERIENCES -

What did I learn in school about persons of a different race? ( Include as many lessons that you can remember)

Did I experience teachers, materials, books with positive models of persons of a different race? (give at least 3 examples if yes)

What were educators' attitudes and behaviors towards children of racial identities different than yours in school?

PEER EXPERIENCES -

What were my friends' attitudes and behaviors toward persons of different races than their own?

What did our play/games tell us about race?

COMMUNITY EXPERIENCES -

What diverse groups/individuals were in my community growing up?

What jokes and stories were commonly told in my community? And about what racial group specifically if race was ever a descriptor in the joke?

RELIGIOUS/FAITH/SPIRITUAL EXPERIENCES -

What did your own religion/faith/spirituality tell you about other religions/faiths?

What racialized images did you see of major religious/faith/spiritual beings/personages?

EMPLOYMENT AND CAREER -

What career models did I have growing up?

How did my parents' or guardians' employment (or lack of employment) influence me?

What jobs did I see persons of my racial identity group doing?

What type of jobs did I see persons of other racial identity groups doing?

CRITICAL INCIDENTS -

What critical incidents happened during my life that might have affected or changed my perception of racism?

RACIAL IDENTITY RESULTS -

And now, how do I view (what are my attitudes, opinions, beliefs, emotions) racism?

How do I behave towards persons of a different racial identity?

What do I say about racism?

What do I not say about racism?

RACIAL IDENTITY IMPACT -

How can all of the above impact my work or relationships with persons of a different racial identity?

What will I change or do differently in order to work effectively or build relationships with people who are of a different racial identity?

GENERAL RACIAL EQUITY REFLECTION -

Do you believe that racial inequity is an issue in your organization or neighborhood?

Do you believe that racial inequity is an issue in Hamilton County/Chattanooga or your respective city?

Do you believe that racial inequity is an issue in the United States of America?

ADDITIONAL QUESTIONS -

What are 3 things you are hoping to gain by attending this training series?

What 2 specific topics would you like to have addressed if time permits?

If you are human, leave this field blank.