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I am a..
 
Female
 
Male
 
Do not wish to disclose
 
 
 
I fall under this age range
 
13-16
 
17-19
 
20-30
 
Above 30
 
 
 
My ethnic back ground is..
 
East / South-East Asian
 
South Asian
 
East European
 
French
 
Arab
 
African
 
Latin American
 
Aboriginal
 
Caribbean
 
Other (Please note)
 

 
 
 
Check which applies to YOU
 
I immigrated to Canada MORE than 20 years ago
 
I immigrated to Canada MORE than 10 years ago
 
I immigrated to Canada MORE than 5 years ago
 
I immigrated to Canada LESS than 5 years ago
 
I was BORN in Canada
 
 
 
My family structure involves..
 
Mother + father + siblings
 
Mother + father
 
Single parent w/ siblings
 
Mother + siblings
 
Single parent
 
Step-parents (one parent or both)
 
Foster parents (adopted)
 
Other (Please note)
 
 
 
 
What kind of educational system do you attend?
 
Public high school
 
Islamic high school
 
Private high school
 
Home school
 
College/ University
 
Not applicable (working/dropped out)
 
 
 
Do you experience difficulty in adapting to Canadian society?
 
Always
 
Often
 
Sometimes
 
Never
 
I don’t believe in adapting to Canadian society
 
 
How strong is your sense of belonging to Canada?

 
Out of five please note, one being extremely weak and five being extremely strong
 
 
 
And would you say your sense of belonging to Canada has changed since five years ago?
 
 
It has become stronger
 
No change
 
It has become weaker
 
I haven’t lived in Canada for five years yet

 
 
 
Which of the following would you consider to be most important parts of your identity? You may choose more than one option.
 
 
Being Canadian
 
Being Muslim
 
Being part of an ethnic/cultural group