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Hi there.

I am really sorry to take a little bit of your precious time but this is for my English Thesis which I have to submit by the end of the year. I will be really grateful if you answer this survey for me.

This is just a short survey about Racism.

Thanks again for your kind cooperation. :)

- Katrice
 
 
 
* 1. For you, what is racism?
   
 
 
 
* 2. Have you ever experienced racism?
 
Yes
 
No
 
 
 
* 3. What kind of racism have you experienced?
 
Age
 
Social Status
 
Social Class
 
Color
 
Genes
 
Height
 
Linguicism
 
Looks
 
Mental Thinking
 
Rank
 
Religion
 
Sex
 
Sexuality
 
Weight
 
I have not experienced Racism
 
Other
 

 
 
 
* 4. What do people name you? (For example, Fat Pig, Big Whale, Charcoal)
   
 
 
 
* 5. What is your stand on Racism?
   
 
 
 
* 6. Name:
   
* Section:
   
* E-Mail:
   
 
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