By

Carol Anderson Anway

and

Jodi Tahireh Mohammadzadeh

Directions : Thank you for your willingness to respond to this questionnaire. There are two parts to it. The first and last pages are easy- just collecting information. The rest of the pages present questions for you to respond by writing down your own experiences.

After filling out page one, respond about your own personal experiences using the questions in small print to guide your responses where appropriate. You may write in the spaces on the questionnaire or on separate sheets of paper.

Please feel free to make copies of this questionnaire and introductory letter to give to other American-born women who have converted to Islam. Encourage them to fill it out and return it within 6 weeks after receiving the questionnaire.

1. STATISTICAL DATE

Age

Vocation

Work Status

Education (Circle highest achieved) Grade School High School AA BA/BS MA/ MS Doctorate Other –

Education at time of conversion :.

Marital Status _-_Never Married __ Married Divorced Widowed

If married, nationality of husband Years Married Number of children - Ages_ If school age, are they in Islamic public school_hone school

How many years have you been Muslim?

Check the areas of Islam which you practice :

- Wear cover (Hijab) –

daily prayers –

fasting during Ramadan –

eat only approved meats –

on-going study of Qur'an and Islamic teachings

Name Phone(__)Address.