A Preliminary Survey

First Name

Last Name

Please enter your email address

Please enter your best contact phone number
(area code first)

How long have you been a practicing Muslim?

   yrs

Which Islamic community did you
belong to when you first accepted Islam?  

(i.e., Nation of Islam, Dar as Salaam,
Ansaru Allah, Community Mosque, etc.)

Which Islamic community
do you belong to now?

In what city have you spent most
of your Islamic community life?

In what city do you currently live?

How important do you think it is it to tell
the story of African American Muslims?

-- Critically important Very important Somewhat Important Not important

Please select the components of our project
that you are interested in learning more about

(Press the ctrl key to make multiple selections)

Future Surveys Oral history project Video documentary All the above

How did you find out about this project?
(Press the ctrl key to make multiple selections)

MANA Conference Email Flyer Word of Mouth Other (mention below)

Please make any additional comments or questions below