Seed Parent Interview

SEEDID:______

IID:______

SEED PARENT INTERVIEW

WAVE # 1

THANK YOU for filling out this questionnaire. We want to understand more about American Indian children and their parents.

Many questions are very sensitive and personal. We truly appreciate your honest answers.

You can skip any question.

You can stop at any time.

Please answer exactly as you think and feel.

Your answers will be kept CONFIDENTIAL.

Your identity and the identity of your community will not be revealed.

There are no right or wrong answers.

Some questions may not seem to apply to you, but please don't skip them unless you’re asked to.

Choose the response that best fits your situation.

Some questions ask you to skip to different places in the booklet depending on the answer you give.

This will prevent you from having to answer questions that do not apply to you.

Be aware that there are several styles of questions.

For most, you'll circle or check only one answer; but some ask you to CIRCLE ALL THE ANSWERS THAT APPLY.

If there is not an appropriate answer for your situation or feelings, feel free to write your own answers below or next to the question.

Your responses will help us and your community to understand the needs of American Indian families better, so that more helpful programs can be developed.

THANK YOU FOR YOUR TIME!

BACKGROUND INFORMATION

1.What is today's date? ______/______/______

2.What is your date of birth? ______/______/______

CIRCLE OR CHECK THE ANSWER THAT BEST FITS YOUR SITUATION.

3.I am...

0.male.

1.female.

4. What is your degree of Indian blood? Please write in.______

NOTE: Please answer BOTH Questions 5 and 6.

5. Are you Spanish/Hispanic/Latino? Please check “NO” if you are not Spanish/Hispanic/Latino.

___ No, not Spanish/Hispanic/Latino.

___ Yes, Mexican, Mexican Am., Chicano

6. What is your race? Check one or more races to indicate what you consider yourself to be.

CHECK ALL THAT APPLY.

___ White

___ Black, African American, or Negro

___ American Indian or Alaska Native—Print name of enrolled or

principal tribe below.______

___ AsianSpecify.______

___ Pacific IslanderSpecify.______

___ Some other race-Specify______

7.Are you currently in a romantic relationship; that is, do you have a boyfriend, girlfriend, husband or wife (a partner)?

___ No

___ Yes

NOTE:If you are not currently in a relationship, please circle the answer that says that you do not have a partner at this time.

8.How long have you been romantically involved with your current partner?

______Years ______Months______Weeks

88.I do not have a partner at this time.

9.I am currently...

1.married (including a traditional Indian marriage) and living with my spouse.

2.married (including a traditional Indian marriage) but not living with my spouse.

3.legally separated.

4.living with my partner but not married.

5.divorced.

6.widowed.

7.single. I have never been married.

10.My partner is...

0.male.

1.female.

88.I do not have a partner at this time.

11.How old is your partner? ______years old

88.I do not have a partner at this time.

12.My partner is...

1.not Indian Skip to 14

2.Indian  Degree of Indian Blood ______

3.I know my partner is part Indian, but I don't know how much.

4.I don’t know if my partner is Indian.

5.I don’t have a partner at this time.

13.Where are you living?

1. Indian reservation.

2. near an Indian reservation.

3.off the Indian reservation.

14.I am living...

1. in a town or city.

2. in the country or a rural area.

15.My community is...

1.mostly American Indian.

2.mostly White.

3.mostly Hispanic or Mexican.

4.mostly African-American.

5.mixed.

INDIAN CULTURE

If your family speaks more than one tribal language, please refer to the language spoken most often.

1.How often was your tribal language spoken in your house when you were growing up?

1.rarely/never

2.sometimes

3.often

4.almost always

8.I don't have a tribal language.

2.How well can you understand your tribal language when it is spoken?

1.I cannot understand my tribal language when it is spoken.

2.I can understand my tribal language a little when it is spoken.

3.I understand my tribal language when it is spoken.

8.I don't have a tribal language.

3.How well can you speak your tribal language?

1.I cannot speak my tribal language.

2.I can speak it a little.

3.I can carry on a conversation in my tribal language.

8.I don't have a tribal language.

4.How often do you currently speak your tribal language?

1.rarely/never

2.sometimes

3.often

4.almost always

8.I don't have a tribal language.

WHEN YOU WERE GROWING UP, HOW MUCH DID YOURFAMILY LIVE BY OR FOLLOW...

Not at allA littleSome A lot

1.the American Indian way of life?...1...... 2...... 3……………..4

2.the White or Anglo way of life?....1...... 2...... 3……………..4

3. Other way of life

(African American, Hispanic, etc.)…..1………………2………………3……………..4

HOW MUCH DO YOU NOW LIVE BY OR FOLLOW...

Not at allA littleSome A lot

4.the American Indian way of life?...1...... 2...... 3...... 4

5.the White or Anglo way of life?....1...... 2...... 3...... 4

6.Other way of life

(African American, Hispanic, etc.)…..1………………2………………3……………...4

HOW IMPORTANT IS IT TO YOU TO FOLLOW RELIGIOUS OR SPIRITUAL BELIEFS WHICH ARE BASED ON...

Not at all Not very Somewhat Very

ImportantImportant Important Important

7.traditional Indian beliefs?...... 1...... 2...... 3...... 4

(sweats, ceremonies, etc.)

8.the beliefs of the Native

AmericanChurch?...... 1...... 2...... 3...... 4

9.Christian beliefs such

as Catholic, Baptist,

Mormon, etc.?...... 1...... 2...... 3...... 4

10.How important is it for you to

have an Indian partner?...... 1...... 2...... 3...... 4

11.How proud are you to be an American Indian?

1.not at all proud

2.not very proud

3.somewhat proud

4.very proud

8.I do not consider myself to be an American Indian.

WORK AND FAMILY INCOME

1.LAST WEEK, did you do ANY work for either pay or profit? Check “yes” even if you worked only 1 hour, or helped without pay in a family business or farm for 15 hours or more, or was on active duty in the Armed Forces.

___ Yes Skip to 4

___ No  Skip to 2a.

2.a. LAST WEEK, were you on layoff from a job?

___ Yes Skip to 2b

___ No Skip to 2c

b. Have you been informed that you will be recalled to work within the next 6 months OR been given a date to return to work?

___ Yes  Skip to 2e

___ No Skip to 2d

c. LAST WEEK, were you TEMPORARILY absent from a job or business?( for any reason, sick leave, maternity, etc.)

___ Yes  Skip to 3

___ No  Skip to 2d

d. Have you been looking for work during the last 4 weeks?

___ Yes Skip to 2e

___ No Skip to 3

e. LAST WEEK, could you have started a job if offered one, or returned to work if recalled?

___ Yes

___ No, because of own temporary illness

___ No, because of all other reasons (in school, etc.)

3. When did you last work, even for a few days?

___ 2000-2004

___ 1995-2000

___ 1994 or earlier, or never worked

4. a. LAST YEAR, 2003, did you work at a job or business at any time?

___ Yes

___ No  Skip to 5

b. How many weeks did you work in 2003? Count paid vacation, paid sick leave, and military service. Number of weeks: ______

c. During the weeks WORKED in 2003, how many hours did you usually work each week?

Usual hours work each week.Numbers of hours: ______

d. What was your hourly wage? $ ______Per Hour

5. INCOME

Please tell me which number best represents the total income before taxes of all persons living in your household in the calendar year of 2003. What was the total income for all your family combined that year? By family, I mean, those who share your house.

This should include not only wages, salaries, tips, and commissions, but also net income per capita payments from a business or farm, social security, pensions, unemployment or disability compensation, alimony or child support, welfare, dividends, interest, rent or sale of property, and any other money income received by all family members--by you or anyone else in the family living with you.

NOTHING, OR LOSS...... 01

LESS THAN 1,000...... 02

$1,000 - 4,999...... 03

$5,000 - 9,999...... 04

$10,000 - 14,999...... 05

$15,000 - 19,999...... 06

$20,000 - 29,999...... 07

$30,000 - 39,999...... 08

$40,000 - 49,999...... 09

$50,000 - OR MORE...... 10

DON'T KNOW...... 99

5a.What was the total monthly income for all persons living in your house for the past month?

TOTAL $______

5b.Was this more, the same, or less than usual?

MORE...... 1

ABOUT THE SAME...... 2 SKIP TO # 6

LESS...... 3

5c.How much more or less than usual? $______

6.How much of this annual household income was earned or brought in by YOU PERSONALLY LAST YEAR?

IF DON'T KNOW: [Give me your best estimate.]

NOTHING, OR LOSS...... 01

LESS THAN 1,000...... 02

$1,000 - 4,999...... 03

$5,000 - 9,999...... 04

$10,000 - 14,999...... 05

$15,000 - 19,999...... 06

$20,000 - 29,999...... 07

$30,000 - 39,999...... 08

$40,000 - 49,999...... 09

$50,000 - OR MORE...... 10

DON'T KNOW...... 99

6a.What was your total monthly income for the past month?

TOTAL $______

6b.Was this more, the same, or less than usual?

MORE...... 1

ABOUT THE SAME...... 2

LESS...... 3

6c.How much more or less than usual? $______

HOUSING

Please answer the next questions for where you currently live.

1. Are you…..

____renting your home

____buying your home

____already own your home

____living with family

2. Which best describes the place where you live? Include all homes even if vacant.

___ A mobile home

___ A one-family house detached from any other house

___ A one-family house attached to one or more houses (like duplex)

___ Apartment building

___ Boat, RV, Van, etc.

3. How many rooms do you have in your house, apartment, or mobile home? Do NOT count bathrooms, porches, balconies, foyers, halls, or half-rooms.

___ 1 room___ 6 rooms

___ 2 rooms___ 7 rooms

___ 3 rooms___ 8 rooms

___ 4 rooms___ 9 or more rooms

___ 5 rooms

4. How many bedrooms do you have; that is, how many bedrooms would you list if this house, apartment, or mobile home were on the market for sale or rent?

___ No bedroom___ 3 bedrooms

___ 1 bedroom ___ 4 bedrooms

___ 2 bedrooms ___ 5 or more bedrooms

5. Do you have COMPLETE plumbing facilities in the place where you live; that is 1) hot and cold piped water 2) a flush toilet 3) a bathtub or shower?

___ Yes, have all three facilities

___ No

6. Do you have COMPLETE kitchen facilities in the place where you live, that is, 1) a sink with piped water 2) a range or stove 3) a refrigerator?

___ Yes, have all three facilities

___ No

7. Is there telephone service available in your house, apartment, or mobile home from which you can both make and receive calls?

___ Yes

___ No

8. How many working automobiles, vans, and trucks, are kept at home for use by members of your household?

___ None___ 2___ 4___ 6 or more

___ 1___ 3___ 5

9. What are the annual costs of utilities and fuels for the place where you live?

If you have lived here less than 1 year, estimate the annual cost.

Electricity