Project: People and Place in 20th-Century St. Louis--Skinker-DeBaliviere

Interviewee:

Interview Date:

Oral History Project Participant

Biographical Information and Family History

 
Purpose of this Form: to collect information for a brief description of the lives of interviewees to be included with each tape recording and transcript. Complete each section as fully as possible with the interviewee, but please do not press the interviewee to answer any question which seems too personal.


Current Information
 

Full Name [Last, Middle, First]:
 
 

Maiden Name:
 
 

Current Address:
 
 

Home Telephone Number:
 
 

Work Telephone Number:
 
 
 
 

Please indicate here precisely how the interviewee would like his/her name to appear in written materials (First Name) (Middle/Nick Name) (Last Name):
 
 

Family History

Interviewee:

Date of Birth:

Place of Birth [city county state]:

Current Marital Status:

Single [ ]      Married [ ]      Divorced [ ]      Widowed [ ]

Spouse:

Spouse's Name [first middle last]:

Spouse's Date of Birth (Death):  _________________ ( _________________)

Spouse's Place of Birth [city county state]:

Spouse's Occupation:

Mother of Interviewee:
Mother's name [First Middle Last]:
Mother's Maiden Name:

Mother's Date of Birth (Death):  _________________ ( _________________)

Mother's Place of Birth [city county state]:

Mother's Occupation:

Father of Interviewee:
Father's Name [first middle last]:

Father's Date of Birth (Death): _________________ ( _________________)

Father's Place of Birth:

city county state

Father's Occupation:
 

Sisters and Brothers of Interviewee:
 
 
Full Name  Birth Date Death Date  Place of Birth

 

Please indicate the interviewee's rank order of birth in the family (1st born, 2nd, 3rd, etc.): [ __________]
 
 

Children of Interviewee:
 
 
Full Name  Birth Date Death Date  Place of Birth

 
 

Grandchildren
 
 
Full Name  Birth Date Death Date  Place of Birth

 
 


Social History
 

Interviewee's Residential History
 

Please list below the places where the interviewee has lived, and the dates (approximate is okay):
 
 
Street (and address if remembered)  City State/Zipcode  Dates (from when to when)

 
 

Interviewee's Educational History
 
 
Full Name of School City/State/Zipcode Dates (from when to when)  Degree Completed

 
 
 

Interviewee's Work History

Please list below the interviewee's current and most important jobs:
 
 
Job Employer City/State/Zipcode  Dates (from when to when)

 
 
 

Has the interviewee ever received any awards or honors, or held any offices? Please describe, including dates and places:
 
 
Award/Honor/Office  From City/State/Zipcode  Date(s)

 

Interviewee's Religious History
 

Current Religious Denomination:

Current Church Affiliation:

Past Church Memberships (Name, Place):
 
 
 
Church Membership City/State/Zipcode Date(s)