INTERFACE PROJECT - Registration Form
Thank you for sending through your signed consent form to participate in the Interface research project, aiming to explore how young people of Dual Heritage express their identity in different parts of their lives. Please find enclosed your signed copy to keep with the researcher’s signature as well as your own. Should you be younger than 18 years of age, a copy of this form has also been sent to your parents so they are aware that you have consented to participate in the research. We remind you that your participation is voluntary and you are free to withdraw at any time.
This form below is the initial registration form for the project which we ask that you complete and return within 14 days, along with the supplementary information specified. This questionnaire is a one-off which is intended to act as the beginning of a conversation between yourself and the researcher by email. This personal information will remain confidential and any information shared publicly will be made anonymous with all personal data by which you could be identified removed. We will ask you to share personal stories from both cultures which form your heritage and particularly about the experiences of your family in terms of migration, homeland, kinship and culture; what these stories mean to you and what you identify with.
Surname : ______
First Name(s ): __ _
Name by which you prefer to be known : __ _
From which side of your family do you get your surname? ____
Are you ... (please tick one box only) :
Male / / Female / / Gender neutral /Month of birth: Year of birth: __ Place of birth: ___
Ward of Bradford your family lived in when you were born : _ _
How do you describe your national identity/group? _ _
Current address : __ _
__ _
Which ward of Bradford is this in? Is this your family home? _
Who lives with you? (please indicate family relationship) __
__ _
Please describe your racial/ethnic identity in your own words: __
__ _
__ _
__ _
Why do you identify yourself in the above way? (please tick all boxes that apply)
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It is my own sense of personal identity / / My parents are from different racial/ethnic groups /It is the way society sees me / / My ancestors (forebears) before my parents were from different racial/ethnic groups /
It is the group I feel I belong to / / My friends/peers identify me this way /
Some other reason (please specify)
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How important overall is it for you to identify with your known ancestry? (please tick one box only)
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Very important / / Fairly important / / Not important /Why is this?
How important is it for you to identify with all the specific racial/ethnic groups that comprise your known ancestry? (please tick one box only)
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Very important / / Fairly important / / Not important /Why is this?
Do you identify with one part of your known ancestry more than any others? (please tick one box only)
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Yes / / No / / Don’t know /Why is this?
Which of the following general terms for Dual Heritage do you prefer? (please tick one or more boxes)
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Dual heritage / / Mixed race /Mixed heritage / / Mixed parentage /
Multiracial / / Mixed origins /
Some other term (please specify)
No preference / / I never think about it /
Are there any terms (including any of the above) that you find offensive or would not like to see on an official form for any reason? (please tick one box only)
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Yes / / No /If yes, what term(s)?
(please write in)
Why do you find these term(s) offensive or inappropriate?
(please write in)
Do you think terms like ‘Dual Heritage’ and ‘mixed race’ should refer to ... (please tick all boxes that apply)
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People who are mixes of white and black groups only / / People who are mixes of white and any minority racial/ethnic group /People who are mixes of minority racial/ethnic groups excluding white / / People of disparate ethnic origins (e.g. ‘Welsh & Polish’ /
Why is this?
Have you ever reported your racial/ethnic identity differently from the way you usually do now? (please tick one box only)
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Yes / / No /If yes, what were the reasons for reporting your racial/ethnic identity differently?
(please write in)
Can you foresee a future time when you might report your racial/ethnic identity differently from the way you do now? (please tick one box only)
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Yes / / No / / Don’t know /Why is this?
(please write in)
Do you describe your racial/ethnic identity differently in conversation with friends to the way you report it on official forms? (please tick one box only)
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Yes / / No /How do you describe your racial/ethnic identity differently?
(please write in)
Why is this?
(please write in)
What are your family’s ethnic origins? (please tick the appropriate box(es) for both mother and father)
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Your mother’s family: / Your father’s family:White / / White /
Black-Caribbean / / Black-Caribbean /
Black-African / / Black-African /
Indian / / Indian /
Pakistani / / Pakistani /
Bangladeshi / / Bangladeshi /
Pakistani / / Pakistani /
Other (please write in): / / Other(please write in): /
Please explain your family origins in more detail, if the boxes above are not appropriate to your situation.
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Is there anyone in the last three generations of your family (i.e. parents, grandparents and great-grandparents) who was born in a different country? (please detail for both mother’s and father’s family)
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Your mother’s family: / Your father’s family:If yes, what were their reasons for migrating? (please detail for both mother’s and father’s family, as appropriate)
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Your mother’s family: / Your father’s family:THANK YOU FOR COMPLETING THE QUESTIONNAIRE
Please email the completed form to the email address
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