You are on page 1of 1

Personal Information

Name:
Age:
Birthday:
Address:
Birthplace:
Race:
Ethnicity:
Religion:

Questions
1. Have you ever felt discriminated? YES NO
Age
Sex
Height
Weight
Skin color
Clothing
Speech
Income
Education
Marital status
Sexual orientation
Disease
Disability
Religion
Politics
2. Did you ever felt discriminated with other race?
3. Explain how you deal with it?

4. Do you think that one race is superior to others? YES___ NO___


5. Do you think color remains a sensitive issue? YES___ NO___
6. Site situations that you were discriminated?

7. How did discrimination affect your self-perception and your life?

8. If you would be given the chance to propose for policies that would reduce racial-
ethnic discrimination, what would it be?

You might also like