Project: People and Place in 20th-Century St. Louis–Skinker-DeBaliviere
Interviewee:
Interview Date:
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's Name:
first middle last
Spouse's Date of Birth (Death): ( )
Spouse's Place of Birth:
city county state
Spouse's Occupation:
Parents 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'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:
Full Name Birth (Death) Date Place of Birth
( )
( )
( )
( )
( )
( )
( )
( )
( )
Please indicate the interviewee's rank order of birth in the family (1st born, 2nd, 3rd, etc.): [ ]
Children:
Full Name Birth (Death) Date Place of Birth
( )
( )
( )
( )
( )
( )
( )
( )
Grandchildren? Number:
Interviewee's Residential History
Please list below the places where the interviewee has lived and the dates (approximate is okay):
Place (Street, City, State) Dates (from-to)
Interviewee's Educational History
Name of School City Dates (from-to) Year/Degree
Completed
Interviewee's Work History
Please list below the interviewee's current and most important jobs:
Job Employer Place (City, State) Dates
Has the interviewee ever received any awards or honors, or held any offices? Please describe, including dates and places:
Interviewee's Religious History
Current Religious Denomination:
Current Church Affiliation:
Past Church Memberships (Name, Place):