Legacy Registry

NVLP National Registry
Biographical Data Form

To be completed and sent to NVLP for each oral history recorded, so that an individual listing for each elder can be included in the National Registry of African American Oral Histories. The questions will allow scholars and students to search the online Registry database for specific categories of information.

NAME OF PERSON INTERVIEWED:

First: Middle Initial: Last:

GENDER: Male Female

RESIDING IN: City:

(The following contact information (ZIP, PHONE, FAX, AND EMAIL ADDRESS) for the
elder interviewed is not required and will NOT be included on the Registry web site.
It is collected solely to help NVLP keep participants informed of new developments
relating to the Registry)

Zip Code: Phone:

Fax: Email:

AGE:
70-75
76-80
81-85
86-90
91-95
96-100
100+

MARITAL STATUS:
Single
Married
Divorced
Widow(er)

Number of Children:
Number of Grandchildren:
Number of Great Grandchildren:

EDUCATION (Highest level completed):

Elementary School
High School
College
Graduate School

MILITARY SERVICE:

Yes
No

If interviewee served in the military, what branch:

Dates of Service: to

OCCUPATION (If retired, check former occupation):

Professional
Clerical
Service
The Arts
Athletics
Homemaker
Manual Labor
Other (specify)

MEMBERSHIPS: (Interviewee belongs to the following. Check all that apply):

Church Group
Sorority/Fraternity
Community Group
Civil/Human Rights Group
Political Party
Educational Organization

FAMILY HERITAGE:

Interviewee can trace his/her family back to

From this part of the world:

Country: and/or

State:

ETHNIC BACKGROUND (Check all that apply):
African American
Caucasian
Native American
Hispanic
Asian
Other (specify)

NEIGHBORHOOD (Interviewees current neighborhood is primarily):
Integrated
African American
Caucasian
Native American
Hispanic
Asian
Other (specify)

ECONOMIC SELF CLASSIFICATION: (Interviewee considers his or her self to be):
Upper Class
Middle Class
Working Class
Disadvantaged
Other (specify)

INTERVIEWEE HAS PARTICIPATED IN THE FOLLOWING HISTORIC EVENTS OF THE
20TH CENTURY SPECIFICALLY EFFECTING AFRICAN AMERICANS:
Great Migration of African Americans from the south to the north
Harlem Renaissance Activities
Anti discrimination protests prior to the 1950s
Civil Rights demonstrations
Voter Registration Campaigns
March on Washington, 1963
Poor People’s Campaign
Million Man March
Million Woman’s March

POST INTERVIEW (Questions to be completed following the interview)

In what format was the interview recorded (example AUDIO CASSETTE, VHS, Digital, Hi-8, etc.):

LIST THE 5 PRIMARY TOPIC AREAS DISCUSSED DURING THE INTERVIEW
(for example – the Civil Rights Movement, Childhood Memories, First Experience
With Discrimination, Marriage, Children, Career, etc.)

Topic 1

Topic 2

Topic 3

Topic 4

Topic 5

NAME OF INTERVIEWER:

DATE OF INTERVIEW: ,

PLACE OF INTERVIEW: City / Town

REPOSITORY CONTACT INFORMATION

PLACE WHERE THE INTERVIEW TAPE IS BEING STORED:

First: Middle Initial: Last:

Street Suite, Apt. #

City: Zip:

Phone: Fax: Email:

Please check the form for mistakes and omissions before submitting.