JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Interracial Relationships in Canada
Please answer all questions, including open-ended questions (unless otherwise instructed), circle the response range number that best reflects your awareness about the following and you should choose the answer that you think is the best, by check marking where ever applicable.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
1. What is your gender?
*
Male
Female
2. What is your age?
*
under 18
18 – 25
26 – 35
36 – 45
46 – 55
56 – 65
66+
3. What is your racial background?
*
Check all the apply
African Canadian
Chicano/Chicana
East Asian Canadian (Ex: Chinese Canadian)
European Canadian
Latino/a Canadian
Middle Eastern Canadian
Native Indian Canadian
Pacific Islander Canadian
South Asian Canadian (Ex: Indian Canadian)
Other:
Required
4. What is your level of education?
*
Did not graduate high school
High school diploma
College/ university diploma
Beyond college/ university diploma
Other:
5. Do you have any religious affiliation(s)?
*
Your answer
6. What is your annual income? If you are a student please answer according to your parent’s annual income.
*
$0-$15,000
$15,001-$30,000
$30,001-$45,000
$45,001-$60,000
$60,001-$75,000
$75,001-$90,000
over $90,000
7. I consider my elementary school experience as multicultural.
*
(Multicultural – many different ethnic backgrounds)
Not Multicultural
1
2
3
4
5
6
7
Very Multicultural
7. a) The numbers of different racial groups that attended my elementary school were:
*
This question pertains to the question stated above
African Canadian
Chicano/Chicana
East Asian Canadian (Ex: Chinese Canadian)
European Canadian
Latino/a Canadian
Middle Eastern Canadian
Native Indian Canadian
Pacific Islander Canadian
South Asian Canadian (Ex: Indian Canadian)
Other:
Required
8. I consider my middle school experience as multicultural.
*
(Multicultural – many different ethnic backgrounds)
Not Multicultural
1
2
3
4
5
6
7
Very Multicultural
8. a) The numbers of different racial groups that attended my middle school were:
*
This question pertains to the question stated above
African Canadian
Chicano/Chicana
East Asian Canadian (Ex: Chinese Canadian)
European Canadian
Latino/a Canadian
Middle Eastern Canadian
Native Indian Canadian
Pacific Islander Canadian
South Asian Canadian (Ex: Indian Canadian)
Other:
Required
9. I consider my high school experience as multicultural.
*
(Multicultural – many different ethnic backgrounds)
Not Multicultural
1
2
3
4
5
6
7
Very Multicultural
9. a) The numbers of different racial groups that attended my high school were:
*
This question pertains to the question stated above
African Canadian
Chicano/Chicana
East Asian Canadian (Ex: Chinese Canadian)
European Canadian
Latino/a Canadian
Middle Eastern Canadian
Native Indian Canadian
Pacific Islander Canadian
South Asian Canadian (Ex: Indian Canadian)
Other:
Required
10. I consider my college/ university experience as multicultural.
(Multicultural – many different ethnic backgrounds)
Not Multicultural
1
2
3
4
5
6
7
Very Multicultural
Clear selection
10.a) The numbers of different racial groups that attended my college/ university were:
This question pertains to the question stated above
African Canadian
Chicano/Chicana
East Asian Canadian (Ex: Chinese Canadian)
European Canadian
Latino/a Canadian
Middle Eastern Canadian
Native Indian Canadian
Pacific Islander Canadian
South Asian Canadian (Ex: Indian Canadian)
Other:
11. I am dating/have dated someone from another race.
*
Yes. (If yes, go to 12.)
No. (If no, go to 13.)
12. My girlfriend/boyfriend identifies racially as:
This question pertains to the question stated above
African Canadian
Chicano/Chicana
East Asian Canadian (Ex: Chinese Canadian)
European Canadian
Latino/a Canadian
Middle Eastern Canadian
Native Indian Canadian
Pacific Islander Canadian
South Asian Canadian (Ex: Indian Canadian)
Other:
13. I have a relative/friend that is dating/has dated someone from another race.
*
Yes. (If yes, go to 14.)
No. (If no, go to 16.)
14. My relative/friend identifies racially as:
This question pertains to the question stated above
African Canadian
Chicano/Chicana
East Asian Canadian (Ex: Chinese Canadian)
European Canadian
Latino/a Canadian
Middle Eastern Canadian
Native Indian Canadian
Pacific Islander Canadian
South Asian Canadian (Ex: Indian Canadian)
Other:
15. My relative's/friend girlfriend/boyfriend identifies racially as:
This question pertains to the question stated above
African Canadian
Chicano/Chicana
East Asian Canadian (Ex: Chinese Canadian)
European Canadian
Latino/a Canadian
Middle Eastern Canadian
Native Indian Canadian
Pacific Islander Canadian
South Asian Canadian (Ex: Indian Canadian)
Other:
16. People date interracially because they feel they are physically attracted to specific partners of a different race in the Canadian society.
*
Strongly Disagree
1
2
3
4
5
6
7
Strongly Agree
Comments to the above question
Your answer
17. People date interracially because they do not see their own racial group and chances are they will not connect romantically with someone of their own race.
*
Strongly Disagree
1
2
3
4
5
6
7
Strongly Agree
Comments to the above question
Your answer
18. People date interracially because they had friends of other racial backgrounds growing up.
*
Strongly Disagree
1
2
3
4
5
6
7
Strongly Agree
Comments to the above question
Your answer
19. The representation of Canadian television media accurately depicts interracial relationships
*
When answering these questions, please keep in mind your first set of answers on racial diversity when you were growing up.
Strongly Disagree
1
2
3
4
5
6
7
Strongly Agree
Comments to the above question
Your answer
20. The current television media is accurately depicting the growth of interracial relationships in Canadian society.
*
When answering these questions, please keep in mind your first set of answers on racial diversity when you were growing up.
Strongly Disagree
1
2
3
4
5
6
7
Strongly Agree
Please explain the above question
*
Your answer
21. The misrepresentation of media affects interracial relationships in Canadian society.
*
When answering these questions, please keep in mind your first set of answers on racial diversity when you were growing up.
Strongly Disagree
1
2
3
4
5
6
7
Strongly Agree
Comments to the above question
Your answer
22. I feel that the representation of television media depicted(s) my interracial relationship accurately.
This question should only be answered by those who have dated interracially.
Strongly Disagree
1
2
3
4
5
6
7
Strongly Agree
Clear selection
Please Explain your above answer
Your answer
23. The representation of media on interracial relationships has increased my chance to date interracially.
*
This question may be answered by all surveyors.
Strongly Disagree
1
2
3
4
5
6
7
Strongly Agree
Please Explain your above answer
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
