The Port Coquitlam Heritage
and Cultural Society


150-2248 McAllister Avenue
Port Coquitlam, BC
V3C 2A5
(604) 927-8403

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info@pocoheritage.org

My Journey - Online Questionnaire

Thank you for participating in this program and sharing your journey with us. Your involvement helps us to tell the story of our culturally diverse community as part of our 2017 exhibit "Journeys and Connections".

Please fill out as much as you are comfortable with. Leave out any areas you are not comfortable answering. Please Note: This questionnaire is intended for people who live or work in, or have lived or owrked in Port Coquitlam or Coquitlam and surrounding area.

CURRENT CONTACT INFO

This information will only be used so we can contact you. Only your first name and city will be public. Items marked with * are required.
*Full Name:
Address:
*City:
Phone (Home):
Phone (Mobile):
*Email:
 

DELEGATION

If you are filling out this form for someone else, like a parent or grandparent please fill out this section, otherwise you can skip to the next section. If you are a delegate you must fill this out and check off the box below. Everywhere you see "you" please fill in as if you are the person.
I am filling out this form for:
Relationship to me:
I certify that the person I am filling this out for is aware of and approves of this information being made available. If the person is deceased please check with their closest living relative.
 

ORIGINS

Please tell us a little about your background. If you were born here that is OK too.
*Where were you born? (be as specific as you can)
In what year (or decade) were you born?
*In what year did you arrive in Canada?(If you were not born here)
*In what year did you arrive in this area?(If you were not born here)
What country (or countries) are you currently a citizen of?
How did you get here? Please tell us a bit about your journey and the challenges you faced getting here.
 

LANGUAGES AND TRADITIONS

Growing up what was (were) the main language(s) spoken in your home?
What language(s) do you mostly speak today?
What customs and traditions from your families past do you most cherish?
What NEW customs and traditions have you adopted, if any?
 

YOUR NEW HOME

What do you most love about living here?
What do you most miss about your previous home?
What, if anything, would make you feel more comfortable here?
How have you kept in touch with friends and family back home?
Overall, what would you like to say to Canada and to your community?
 

INFORMATION RELEASE

*I give the Port Coquitlam Heritage and Cultural Society (PoCo Heritage), a non-profit society, permission to use this information and any accompanying items I provide (photos, artifacts, etc) as part of their heritage and cultural programming, including, but not limited to, the following: museum displays, statistics, museum programs, online content and promotional material. I understand this information will be used only for the purposes of community education and engagement. By checking off this box and pressing submit I acknowledge this.

If you are willing we'd love to talk to you some more. Please check off any of the following and we will be in touch.
I am interested in being interviewed and possibly having my story put on video
I wish to receive your newsletter and email updates
I am potentially interested in becoming a member and/or volunteering
I have photos, letters, cultural or other items I would like to make available for this exhibit
Please enter the words in the box below
You will receive a copy of this submission by email, which you can save or print off if you wish.



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