Your Community and the World
Handout 1: "Survey Format"

Instructions: In each of these ten categories, you should identify a minimum of five separate items. Use additional paper as needed. GROCERY Name___________________________________ Product Brand Name Country _________________________________________________________ NEWSSTAND Name___________________________________ Magazine/Newspapers Language Country _________________________________________________________ TRAVEL AGENCY Name___________________________________ Destination Advertised Country _________________________________________________________ MUSIC STORE Name___________________________________ Performer Title of CD Country of Origin _________________________________________________________ BANK Name___________________________________ Foreign Currency Country Exchange Rate (How many=US$) _________________________________________________________ RESTAURANT Name___________________________________ Country of Food Specialty _________________________________________________________ MOVIE THEATER Name___________________________________ Theater Name Movie Title Country of Origin _________________________________________________________ HOUSE OF WORSHIP or CHARITABLE ORGANIZATION Name Project Country Involved _________________________________________________________ VARIETY STORE Name___________________________________ Product Brand Name Country of Origin _________________________________________________________ PEOPLE Person’s Name Relationship to Me Country of Origin _________________________________________________________