Attachment B_StoryCorps Participant Data Sheet

PARTICIPANT DATA SHEET
StoryCorps
collects information from every participant to ensure that our archive fully represents people of
StoryCorps collects information from every participant to ensure that our archive fully represents people of all backgrounds. For children
all
backgrounds
beliefs.
encourage
answer
asguardian
many of
questions
asinformation
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but
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the child. All
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andparticipant
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to StoryCorps Privacy Policy. (https://archive.storycorps.org/privacy-policy/)
PERSONAL INFORMATION
Relationship: I am my interview partner’s
Title:

Name:

Address:
City:

State:

Phone number: (

Zip/Postal code:

Country:

)

E-mail:
Date of Birth:

month

/

day

/

City of Birth:

year

State of Birth:

Country of Birth:

DEMOGRAPHIC SURVEY
Race/Ethnicity:

(check all that apply)

American Indian or Alaska Native
Asian
Black/African American

Hispanic or Latino/Latina
Native Hawaiian
or Other Pacific Islander

White/Caucasian
(please specify)

We encourage you to use this space to describe your identity in your own words:

STORYCORPS USE ONLY (do not write in this section)
Initiatives:
Griot
Date of Interview:

Military Voices

Historias

Time of Interview:

OutLoud

September 11th

Location of Interview:

Memory Loss
Facilitator:
3.2017
4.2020