* 1. What is your race.

* 2. What gender are you?

* 3. Have you ever experienced racism, and if you did tell me what happen.

* 4. Where have you experienced racism at?

  Yes Not sure No
the playground
school
at home
at church
at the grocery store
on the bus
at another family members home

* 5. Do you have an idea of stopping racism?

* 6. Has anyone said anything that was racist to you?

* 7. Have you stood up for someone who was getting rude comments about their race?

* 8. Have you been in this situation and has anyone stood up for you?

* 9. Have you ever been racist to anyone or anybody?

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