Adult Refugee Interview Questionnaire from Daniel Keeran, MSW College of Mental Health Counselling, Victoria, BC, Canada www.collegemhc.com This questionnaire can be used following a security screening of refugee claimants, either before or after entry to the country of refuge.
IDENTITY 1. 2. 3. 4. 5.
Name ___________________________________________ Gender __________________ Age______ and birthdate ___________________________ Single, married, or divorced__________________________ What is your hometown, village, or city you are from?
RECENT HISTORY 6. How long have you been away from home? 7. What was happening at the time you left home? 8. What would you like for people to know about what happened? 9. What have you learned or gained from what happened to you? FAMILY AND FRIENDS 10. How many members are in your family? First names, gender, and age. 11. What deaths have occurred? 12. Who did you leave behind? Friends? Family? 13. Among your siblings, which one are you in the birth order, oldest to youngest? 14. Please list other friends and relatives’ names and their contact information such as phone, email, facebook page, etc. May we contact them to receive money on your behalf? (their email is required) EDUCATION, TRAINING, AND EMPLOYMENT 15. What was your occupation or profession in your country? 16. What skills do you have? 17. What is your highest level of education? 18. What languages do you fluently speak? 19. What kind of employment are you hoping for? 20. What training might you need to achieve your goals?