In Search of Roots

Paternal and Maternal Ancestral Villages Information

Intern ______________________Chinese Name_________________________

Paternal Side (Write in English and Chinese names)

Village （市，镇，县，乡，村）__________________________________________

Father （父亲）_________________________________________________________

Grandfather （祖父）____________________________________________________

Grandmother（祖母）____________________________________________________

G Grandfather（曾祖母）_________________________________________________

G Grandmother（曾祖父）________________________________________________

Person who was the last to leave the village____________________________________

Person who first came to the USA and year entered______________________________

Other information________________________________________________________

Maternal Side (Write in English and Chinese names)

Village （市，镇，县，乡，村）__________________________________________

Mother （母亲）________________________________________________________

Grandfather（外祖父）___________________________________________________

Grandmother（外祖母）__________________________________________________

G Grandfather（外曾祖父）_______________________________________________

G Grandmother（外曾祖母）______________________________________________

Person who was the last to leave the village____________________________________

Person who first came to the USA and year entered______________________________

Other information_________________________________________________________