Interviewee Intake Form: Maryland Lynching Truth, Racial Healing, & Transformation Oral History Initiative
Thank you so much for agreeing to conduct an oral history interview, and we look forward to amplifying and preserving your testimony. Questions about this form or the Initiative? Contact Jack Del Nunzio: mdlynchingsoralhistory@gmail.com or (443) 974-3347
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电子邮件地址 *
Full Name of Interviewee
Corresponding County/Regional Coalition
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Interviewee Mailing Address
City
State
Zip Code
Phone Number
Email Address
Place of Birth
Date of Birth
年
/
月
/
日
What is your racial/ethnic background?
What is your gender identity and/or pronouns?
Which of the following best describes you?
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I would prefer:
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Due to this work's sensitive nature and the realities of historical trauma, our goal is to provide counseling support for interviewees. Are you interested in having access to a licensed/certified social worker with trauma-informed and cultural responsiveness training before, during, and/or after your interview?
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If you selected a synchronous interview, in-person interview, or phone interview above, please visit the following link to schedule your interview: https://mdlynchingsoralhistory.youcanbook.me
Do you possess relevant artifacts (documents, pictures, digital files, etc.) that you wish to have archived? If so, please describe them below:
If yes to the above, will you require assistance with your archival materials? The initiative is able to provide scanning and digitization services.
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Use the space below to pose questions about the initiative or provide additional information about yourself. We will reach out via email or phone in the near future to answer your questions and discuss next steps.
您回复的副本将通过电子邮件发送到您提供的地址。
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