for adults, adolescents, and children

1. 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. Name ___________________________________________
2. Gender __________________
3. Age______ and birthdate ___________________________
4. Single, married, or divorced__________________________
5. 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?

2. FINANCES AND CONTACT
21. What money can you access? Do you have a bank account?
22. Do you have an email address? Enter it here
__________________________________________________________
23. What is the value of property you have left behind in your former
country?
24. If money was sent to you, how could you receive it?
25. Can you access funds from a BOM/ATM?
26. What is your exact current mailing address or address of the camp or
location where you are now living?
27. What clothing and food items do you need?
28. How long do you expect to remain where you are staying now?
29. Where do you hope to finally live and work?
PERSONAL NEEDS AND REFLECTIONS
30. What do you need in order to feel safe and happy?
31. What health problems do you have?
32. Do you want to remain in Canada? If possible, do you want to return to
your former home?
33. How would you like to make the world a better place?
34. What is the hardest part about leaving your former country?
35. What is the hardest part about living in Canada?
36. What do you like to do for fun?
37. What do you worry about?
38. Say something about love.
39. What encourages you or helps you feel happy?
40. If you had three wishes, what would they be?
41. What are your hopes and dreams for the future?

3. Adolescent Refugee Interview Questionnaire
from Daniel Keeran, MSW
College of Mental Health Counselling, Victoria, BC.
www.collegemhc.com
1. Name __________________
2. Gender_________________
3. Age ______ and birthdate _________________________
4. Single, married, or divorced _________________________
5. What is your hometown, village, or city you are from?
6. How long have you been away from home?
7. Can you read and write? If so, in what languages are you fluent?
8. Do you enjoy reading? Give an example and say why you enjoy it.
9. Did you go to school in your country?
10. How many members are in your family? Which one are you in the
birth order?
11. What would you like for people to know about what happened?
14. What have you learned from what happened to you?
15. What encourages you?
16. If you had three wishes, what would they be?
17. What are your hopes and dreams for the future?
18. What skills do you have?
19. What is your highest level of education?
20. What languages do you fluently speak?
21. What kind of work or job are you hoping for in the future?
22. What training might you need to achieve your goals?
23. What do you need in order to feel safe and happy?
24. What health problems do you have?
25. Do you want to remain in Canada or return to your former home?
26. How would you like to make the world a better place?
27. What is the hardest part about leaving your former country?
28. What is the hardest part about living in Canada?
29. What do you like to do for fun?
30. What do you worry about?
31. Say something about love.

4. Child Refugee Interview Questionnaire
from Daniel Keeran, MSW
College of Mental Health Counselling, Victoria, BC.
www.collegemhc.com
1. Name __________________
2. Gender_________________
3. Age ______ and birthdate _________________________
4. Birthplace or city you are from _______________________
5. What happened to you?
6. Did you go to school? What grade? What are your favourite subjects
in school?
7. When are you happy?
8. What is fun for you?
9. What do you like to eat? Your favourite food?
10. What is your favorite thing to play?
11. Do you have one or more friends?
12. Who or what do you worry about?
13. Who are you closest to in your family? Are they with you?
14. What do you want to be when you grow up?
15. What is your favourite colour?
16. What is a favourite game?
17. What would you like to see happen for you and your family?
18. Do you like to read or draw or colour?
19. What do you think about just before you go to sleep at night?