LIFE HISTORY FORM

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:  ______________________________________________

__________________________________________________________________________________________________

COMMENTS:  ____________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

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GO TO: ORAL HISTORY RELEASE FORM