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* 1. Please enter the information below:

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* 2. What is your gender?

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* 3. Choose one or more races/ethnicities you consider yourself to be. Check all that apply:

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* 4. How many helpful and safe adults do you have in your life right now?

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* 5. How many hours each WEEK do you usually help out in your community? (For example: volunteering,
picking up trash, assisting elders, helping friends make good choices, etc.)

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* 6. How many hours each WEEK do you usually spend out in nature?

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* 7. Please mark how much you agree or disagree with the following statements.

  Ranking:
The land I live on is important to me
I feel good when I participate in
cultural activities
I try to be physically active outside
I feel my community needs me
I make my community a better place
When we take care of the land, the
land takes care of us

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* 8. How would you describe your involvement to the following activities? Choose only one ranking:

  Ranking
Talking/sharing circles
Fishing and/or hunting
Community activities
Harvesting (picking berries/
collecting food from nature, etc.)
Other

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* 9. Mark how much you agree or disagree with the following statements. 
Definition: Your Ethnic Group is your cultural group or the culture group of your ancestors. Example: Native Tribe.

  Ranking
I have spent time trying to find out more about my ethnic group, such as its history, traditions, and customs
I have a strong sense of belonging to my own ethnic group
I understand pretty well what my ethnic group membership means to me
I have often done things that will help me understand my ethnic background better
I have often talked to other people in order to learn about my ethnic group
I feel a strong attachment towards my own ethnic group
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