PINE MOUNTAIN SETTLEMENT SCHOOL
SERIES 00: ARCHIVE
Life History Form
ORAL HISTORY LIFE HISTORY FORM
Pine Mountain Settlement School Archives & Collections
36 Highway 510, Pine Mountain, Kentucky 40810
Ph: 606-558-3571
(This form should accompany the Oral History Release Form.)
Interview date: _______________________________________________________________________________
Interview location: ____________________________________________________________________________
Format and duration of interview: ____________________________________________________________
Interviewee name: _____________________________________________________________________________
Interviewer name: ______________________________________________________________________________
Birth date of interviewee: _______________________________________________________________________
Birthplace: ______________________________________________________________________________________
Education: ______________________________________________________________________________________
Relationship to Pine Mountain Settlement School: ______________________________________________
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COMMENTS: ____________________________________________________________________________________
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GO TO: ORAL HISTORY RELEASE FORM