Heritage cultural assessment

Where was your mother born? North America 2. Where was your father born? North America 3. Where were your grandparents born? North America (1) Your mother’s mother? North America (2) Your mother’s father? North America (3) Your father’s mother? North America (4) Your father’s father? North America 4. How many brothers and sisters do you have? 2 brothers and 2 sisters 5. What setting did you grow up in? Urban, Rural Suburban _____ Rural 6. Father _____ Born in the U. S. When you were growing up, who lived with you? _____ Mother, Father and extended family. Have you maintained contact with a. Aunts, uncles, cousins? (1) Yes _____ (2) No _____ Yes b. Was your original family name changed? (1) Yes _____ (2) No _____ No 14. What is your religious preference? (1) Catholic _____ (2) Jewish _____ (3) Protestant _____ (4) Denomination (5) Other _____ (6) None _____ Catholic 15.