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    Black Identity & Acculturation Study

    Danielle Leach, founder of UBAWA, is currently working on her dissertation for her PhD and has developed a Mental Health and Wellness pilot program catered towards self-published authors that identifies various psychological and sociocultural factors that influence an author's likelihood for success. To measure the effectiveness of the program, she is seeking authors to participate in a 16 week long study where all program materials will be provided to participants free of charge. Your responses will be kept confidential. There are 3 sections total, including a demographic section, the CRIS, and the AAAS scales. The CRIS scale contains 40 questions and the AAAS scale contains 47. Please answer each question honestly. By completing this form, you consent to participate in this study.

    Approximate time to complete: 15-20 minutes

    SECTION I (Demographic Info)

    SECTION TWO (CRIS)

    Instructions: Read each item and indicate to what degree it reflects your own thoughts and 
    feelings, using the 7-point scale below. There are no right or wrong answers. Base your responses on your opinion at the present time. To ensure that your answers can be used, please respond to the statements as written, and place your numerical response on the line provided to the left of each question. ​
    For numbers 13-40, please indicate the extent to which you agree or disagree with the following statements. Refer to the scale provided and list your numerical response for each statement below. 

    1 = Strongly Disagree
    2=  Somewhat Disagree
    3 =  Disagree
    4 =  Neutral
    5 =  Agree
    6 =  Somewhat Agree
    ​7 =  Strongly Agree
    ​
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree

    SECTION THREE (AAAS)

    Below are some beliefs and attitudes about religion, families, racism, Black people,  White people, and health. Please tell us how much you personally agree or disagree with these beliefs and attitudes by circling a number. There are no right or wrong 
    answers, we simply want to know your views and your beliefs. ​Please indicate the extent to which you agree or disagree with the following statements. Refer to the scale provided and list your numerical response for each statement below. 

    1 = Strongly Disagree
    2=  Somewhat Disagree
    3 =  Disagree
    4 =  Neutral
    5 =  Agree
    6 =  Somewhat Agree
    ​7 =  Strongly Agree
    ​

    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
    1 = Strongly Disagree 2= Somewhat Disagree 3 = Disagree 4 = Neutral 5 = Agree 6 = Somewhat Agree ​7 = Strongly Agree
Submit

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  • Home
  • About
    • Subscribe
    • Membership
    • Founder
  • News
    • Couples Feature
    • Conversations
    • Black vs African-American
    • Top 100 AA Authors >
      • AA Authors
    • UBAWA Documentary
    • Black Lives Matter
  • Projects
    • Black Identity Study >
      • Black Identity Study Form
    • The Doll Test
    • Black Men's Dating Preferences
    • Black Men's Perspectives
    • Black Lives Matter
  • Programs
    • The African Kingdom Experience
    • Dream Pathways
    • Dream Pathways Kids
    • UBAWA
  • Academy
  • Resources
    • Black Business Directory
    • Who's Who in AA Literature
    • Publications
  • Films
  • Museum
  • Store
  • Events
    • RSVP
  • Contact