Pre-Interview Questionnaire

[Isaiah Swanson]

PART A: GENERAL INFORMATION
Name:
(Last)
(First) (Middle)
Maiden name (if applicable): ______________________
Occupation: _______________________________
Date of birth: _______________
Have you ever been interviewed about your personal history/
experiences? _______
If yes, organization(s) or Individual(s) that conducted interview:
______________________
May this preliminary interview questionnaire influence the types of
questions to be asked in the interview?
_____Yes _____No
Part B: CHILDHOOD
Place of Birth:
__________________________________________________________
Where did you grow up?
(City) (State)
(Neighborhood)
Who lived in your house with you?
Where did you go to school?
Elementary
___________________________________________________________:
Junior
High____________________________________________________________:
High School
___________________________________________________________:
Post-Secondary Education:
______________________________________________
Part C: BACKGROUND
Do you consider yourself a member of any religion? If so, what
religion and denomination? (Optional)
Did you serve in the military? If so, when and where did you serve?
Have you been a member of any political organizations or community
organizations?
What kinds of cultural, religious, or sporting activities were you
involved in growing up?
This page of the questionnaire is CONFIDENTIAL and to be reviewed
only
by the Documentary Team.
Part D: HYDE PARK
How long have you lived in Hyde Park?
Did you participate in any civil rights activities during the
1950s-1970s?
What is your proximity to Cypress Creek?
Has your proximity to the creek affected you in any way?
Part E: Is there any additional information that you would like us to
know before we interview you?
INTERVIEWEE CONTACT INFORMATION
Address::
______________________________________________________________
(Street)
_______________________________________________________________
(City) (State) (Zip)
Home Phone: __________________________
Work Phone: ___________________________
Second Address:
_______________________________________________________
(Street)
_______________________________________________________________
(City) (State) (Zip)