2022-2023 BFB #MyStory "Finding Balance" Episode Storyteller Candidates Form

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Thank you for your interest in becoming a storyteller to support the BFB #MyStory program. In the 2022- 2023 school year, BFB #MyStory plans to do a "Finding Balance" episode in which we will pair up adults and teenager journalists, writers and podcaster interviewers to have a dialogue on "Finding Balance" from your life stories.

At the moment, we can only accept a limited number of storytellers. Please complete this form and we will send you an email/text if you are accepted.

Thank you!

BFB #MyStory Program Team

Email *

First and Last Name

The title you prefer in front of your name?

Mr.

Mrs.

Ms.

Other:

Clear selection

What is your country of origin or ethnicity?

How many years have you been in the US?

Your religion, if any

Which area in WNY are you currently living in?

Please briefly describe your life experiences after you moved to US and the reasons why you are open to sharing this in BFB#MyStory program?

What language would you prefer to communicate with these young students (13-20 years old) when you share your life story with them?

What times are you typically available in? (to have the interview with the students)

Morning

Afternoon

Evening

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Photo Release Consent

I give consent to the BFB#Mystory program to use my photos taken specifically for this program in exhibits in physical and digital sites

I don't give consent to the BFB#Mystory program to use my photos taken specifically for this program in exhibits in physical and digital sites

Clear selection

Is there any potential company or individual that you believe would be interested in sponsoring your story's exhibit production?

Is there anything else that you would like us to know so that we can ensure the communication between you and the #Mystory team is culturally appropriate? (ex. special rules the team would need to follow if we visited you in person?)

May we have your phone number in order to notice you of this program progress?

A copy of your responses will be emailed to the address you provided.

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