1. Please list the Interviewer(s)' name(s).

   Name

2. Please provide information about the Interviewee(s).  Spelling counts!

   Name
   Street Address
   Address (cont.)
   City
   State
   ZipCode
   Work Phone
   Home Phone
   FAX
   E-mail

3. Date(s) of interview (mm/dd/yr) :

   
   
   
   
   

4. Where did the interview take place?  NOTE: Please type city, state (i.e. Washington, DC or Wilmington, NC etc.)  If you have additional details to add about the place (i.e. "Interview took place in the home of Mrs. Jane Doe", please include that in the abstract.)

   
   

5. How many tapes are there for this interview?

   
   

6. What is the total run time of this interview (in minutes)?

   
   

7. If this interview is part of a Series, enter the Series name below. (For example, Voices of UNCW, SENC Notables, etc.)

   
   

8. If this interview belongs to a Sub-series, enter the Sub-series name below.

   
   

10.  Please indicate if VHS or DVD copies should be made for the following (Please specify whether VHS or DVD in #12.):

 Interviewee: select the number of copies needed.  0 1 2 3 4
 Special Collections:  select the number of copies needed. 0 1 2 3 4
 Archives: select the number of copies needed. 0 1 2 3 4
 Reserves Desk: select the number of copies needed. 0 1 2 3 4
 Other: select the number of copies needed. 0 1 2 3 4

11.    Please provide an abstract of the interview. What were the major themes discussed? If any proper names were discussed in the interview that  might be hard to discern from the tape, include them here.

12.  Do you have any additional comments or notes about this interview? If you want copies made for interviewee, specify if they should be DVD or VHS.