Are you a Navajo?
Yes
No
Do you live within Gallup city limits,
or did you attend school(s) in Gallup?
Yes
No
Are you over age 18 now?
Yes
No
State your exact age today:
Do you speak Navajo?
Yes
No
What is your level of Navajo Language Fluency?
Good: I speak and understand the Navajo language
Fair: I understand the Navajo language but do not speak
it fluently
Poor: I have little or no knowledge of the Navajo language
What is your gender?
Male
Female
Are you employed right now?
Yes
No
Your Employment right now is:
Full-Time with Benefits
Part-Time with no Benefits
Several Part-Time Jobs
Not Employed
What is your Annual Income now?
Under $17,000 per year
$17,000 to $25,000 per year
$25,001 to $35,000 per year
Over $35,000 per year
Did you graduate from High School?
Yes
No
Did you earn a GED from High School?
Yes
No
Did you drop out of High School?
Yes
No
If you dropped out, please give the main reason for dropping
out:
Were you expelled from High School?
Yes
No
What curriculum did you study in High School?
Regular Education
Vocational Education
Special Education
Bilingual Education
Advanced Placement Classes
Gifted and Talented Classes
Did you participate in Extracurricular
Activities during High School?
Yes
No
Did you participate in a free breakfast/lunch
program when you were in High School?
Yes
No
What was your religious preference during high school?
Mormon
Native American Church
Protestant Christian
Roman Catholic
Traditional Navajo Spirituality
Other
None
Traditional: Thinks and speaks
in Navajo, practices Navajo customs.
Marginal: Think and speak in both English and
Navajo, may not feel comfortable in either culture: Torn
between cultures.
Bicultural: Accepted by both Navajo and Anglo
culture.
Assimilated: Totally immersed in Anglo culture,
no longer participate in Navajo culture at all.
Select the choice which best fitted you during high school:
Traditional
Marginal
Bicultural
Assimilated
Was at least one person in your household
employed full-time while you were in high school?
Yes
No
Did you live in a home with electricity
while you were in high school?
Yes
No
Did you live in a home with indoor plumbing
while you were in high school?
Yes
No
How many times did you have contact with
the police while you were in high school?
None
1 to 5 times
6 to 10 times
11 or more times
Were you ever arrested during your high
school years?
Yes
No
Were you ever jailed during your high school
years?
Yes
No
Did you ever seriously consider committing
suicide during your high school years?
Yes
No
Did you ever make a suicide attempt during
your high school years?
Yes
No
Have you seriously considered committing
suicide since leaving high school?
Yes
No
Have you made a suicide attempt since leaving
high school?
Yes
No
Did you lose any family member or close
friend to suicide during your high school years?
Yes
No
Did you lose any family member/close friend
to an alcoholic/drug -related accident during your high
school years?
Yes
No
Below are some statements about your high school and
community. Read each statement carefully. Then choose
the response which most closely is was your perception
at the time you were in high school:
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
1. I resented school because I believed it cheated me
out of my Navajo culture.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
2. I often witnessed racial conflict in my high school.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
3. I often witnessed racial conflict in Gallup during
my high school years.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
4. Gallup is a racially divided community.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
5. I believe Anglos try to keep the best jobs for themselves
in Gallup.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
6. I heard Anglo teachers making fun of Navajo students
in their classrooms.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
7. I experienced racial discrimination when I was in
high school.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
8. I experienced racial discrimination in employment
in Gallup.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
9. I saw Anglo students always picking on Navajo students
when I was in high school.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
10. I had some teachers who were prejudiced against Navajo
students when I was in high school.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
11. My parents were aware of racist practices at my high
school.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
12. I believe the principals never listened to the Navajo
side of the story in a conflict with Anglo students when
I was in high school.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
13. I believe the police are prejudiced against Navajo
in Gallup.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
14. I experienced racial conflict with my teachers when
I was in high school.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
15. I believe the Navajo and the Anglo in Gallup are
engaged in racial warfare.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
16. I heard my teachers say insulting things about Navajo
culture in my classrooms.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
17. The Navajo and Anglo in Gallup conflict economically,
politically, and culturally.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
18. I experienced racial struggle each day when I was
in high school.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
19. I witnessed the police treating Navajo students differently
than Anglo students when I was in high school.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
20. I witnessed fights between Navajo students and Anglo
students in my high school.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
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