Storyteller Questionnaire | TREE of LIFE LEGACIES

Personal History Questionnaire

Please provide brief responses to the questions relevant to you and your life. You can skip sections that don’t pertain to you and jump around as needed. This form is designed for you to return to as many times as necessary before submitting your responses.

IMPORTANT: Your answers are NOT saved unless you
click ‘Save & Continue Later’ or ‘Submit’

Be certain to save your unique link. It’s the only way to re-access your form.

Providing this information enables me to create the outline for our filmed interview session(s). Take your time with this and enjoy reflecting on your life and all the experiences you have had!

Confidentiality:

Your information is private and is never used for any purpose other than to create your personal history video.

Your name:

Use the "Suffix" field to provide your maiden name, if applicable

First Middle Last Suffix

Phone number:

Enter Email Confirm Email

Date of birth:

dd/mm/yyyy

Place of birth:

City, State, Country

MARRIAGE

Spouse's name

Please provide maiden name in "Last" field, when applicable

First Middle Last

Wedding date:

mm/dd/yyyy -- accurate as possible

Wedding location:

City, state, country

Additional info regarding marriage:

If you've been married more than once or are no longer married, please give brief overview of your current status, as would be pertinent to our interview sessions

MOTHER

Your Mother's name:

Provide her maiden name in "Last" field

First Middle Last

Mother's date of birth:

mm/dd/yyyy -- accurate as possible

Mother's place of birth:

City, State, Country - accurate as possible

Mother's date and place of death:

dd/mm/yyyy with City, State, Country - accurate as possible

Mother's Father

First Name Last Name Year of Birth | City+Country of Birth

Mother's Mother

First Name Last Name Year of Birth | City+Country of Birth

Details

If your mother or her parents are immigrants, please specify the year they arrived in the U.S. and the places where they lived.

FATHER

Your Father's name:

First Middle Last

Father's date of birth:

mm/dd/yyyy -- accurate as possible

Father's place of birth:

City, State, Country

Father's date and place of death:

dd/mm/yyyy with City, State, Country - accurate as possible

Father's Father

First Name Last Name Year of Birth | City+Country of Birth

Father's Mother

First Name Last Name Year of Birth | City+Country of Birth

Details

If your father or his parents are immigrants, please specify the year they arrived in the U.S. and the places where they lived.

SIBLINGS

Names of your siblings

Include dates of birth and death, as applicable

CHILDREN

Names of your children

Include dates of birth and death, as applicable

Names of your grandchildren

Include dates of birth and death, as applicable

Names of your great-grandchildren

Include dates of birth and death, as applicable

GEOGRAPHY

Main places you've lived

Include dates and cities/countries, as applicable

EDUCATION

Highest Year of Schooling:

Elementary School

High School

Associate Degree

Bachelor's Degree

Graduate of Professional Degree

Some College

Other

If you have an undergraduate degree, where did you study? What Year did you graduate? Note degree held.

If you have an post-graduate degree, where did you study? What Year did you graduate? Note degree held.

MILITARY

Skip to LIFE HISTORY QUESTIONS if you did not serve in the military

Military Service

Army

Navy

Air Force

Marines

Coast Guard

National Guard

Other

If you checked OTHER, please describe here:

What was your rank/title and what years were you involved?

LIFE HISTORY QUESTIONS

Bullet points work! It's ok to be brief, this helps me get to know what's been important to you.

Important Stories:

If there are specific stories, events, et cetera you would like to be sure are included, please briefly note them here.You can fill in more specifics for that area if it is included in this questionnaire.

Description of myself, how I define myself in the world:

My most treasured memory:

Love ~ What I remember most about being in love:

My thoughts when I met my spouse for the first time:

My best and longest friendship:

My proudest moments as a parent were:

What I learned from being a parent:

The greatest joy of being a Grandparent/Great-grandparent is:

Most memorable gift I ever gave or received:

My family tradition that is most important to me:

Some of my skills and talents learned over the years:

My favorite job:

Volunteering I have done:

Hobbies I have done:

Main hobbies you have done - please include approximate year started.

Travel or Vacations:

Please list most memorable or favorite(s) with dates):

My greatest achievement has been:

The most outstanding world event(s) to occur during my life:

The one thing that has remained constant through all stages of life:

My main inspirational source in life has been:

A value I hold close to my heart is:

The most valuable lesson I have learned is:

What I hope for my children and grandchildren in the future:

Significant Time In Your Life:

If there is a specific period of life that you would like us to focus on, please give a few details:

Are there any topics you would like covered not mentioned above?

SUBMIT OR SAVE & CONTINUE LATER

Printable Questionnaire

Below is the e-version of the questionnarie. If you prefer to hand write your answers, please download the printable version and mail back to me.

Download Now

Personal History Questionnaire

Be certain to save your unique link. It’s the only way to re-access your form.

Confidentiality:

MARRIAGE

MOTHER

FATHER

SIBLINGS

CHILDREN

GEOGRAPHY

EDUCATION

MILITARY

LIFE HISTORY QUESTIONS

SUBMIT OR SAVE & CONTINUE LATER

Printable Questionnaire

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