Interview Request Form | AMMD Pine Grove Oral History Project

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Thank you for your interest in having the AMMD Pine Grove Project interview you or someone you know!

Please complete this form with as much information as possible. Submitted information will help us follow up to schedule an interview and will not be shared or distributed outside of our oral history project team.

We welcome all Cumberland County, Virginia, memories and stories, especially those connected to Black families from the Cartersville area!

To learn more visit: https://www.AMMDPineGroveProject.com

Interviewee Information

Instructions: Please complete the following questions with the information of the person to be interviewed (the "Interviewee").

Name (Rev./Deacon/Dr./Ms./Mrs./Mr., First and Last)
*

Phone Number (including area code)
*

Email Address

Age

Connection to Cumberland? Please select all that apply.
*

Grew up in/near Cartersville area.

Family is from Cartersville area.

Attended Pine Grove School.

Attended other segregated/Black school in Cumberland.

Family were students or teachers at Pine Grove School.

Bethlehem, Mt Calvary, New Hope, or Rising Zion Baptist was/is my family's church.

Other:

Required

Preferred interview time? Please select all that apply. (Note: Interviews typically last approximately 90 minutes.)

Morning

Midday

Afternoon

Evening

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Preferred interview location? Please select all that apply.

At home

Public library

Family church

Over the phone

Remotely/Virtually (computer video chat)

Other:

Any other comments and/or questions?

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