We ask that anyone who is interviewed or seeks to be interviewed completes this form. If you have an interview already scheduled, please have this form submitted at least one week prior to your interview. The contact information you provide here is for our records and will not be made publicly available; however, other information may be used in a biographical note accompanying descriptions of your interview. Please note which responses (in addition to your contact information) you desire to remain confidential in the "Additional Comments" box at the end, and we will ensure that such information remains private.

If you have questions about the questions on this form or how the information will be used, please contact the Project Architect at gina@welovebuhi.com. If you have any questions about how your interview will be archived, please contact the Georgia State University Library Social Change Collection archivist, Katherine Fisher, at 404-413-2880 or kfisher11@gsu.edu.

Name *
Home Address *
Home Address
Preferred Mailing Address
Preferred Mailing Address
If different from home address
Phone *
For U.S. cities, please list the state as well. For international cities, please list the city/town, province if applicable, and country.
Date of Birth *
Date of Birth
The language you prefer to be interviewed in. If this field is not filled out, we will infer you consent to be interviewed in English.
You may list more than one.
Including name(s) of spouse(s)/life partner(s), important dates and places, etc.
Including names, dates, place(s) of birth, etc.
Including name(s) of school(s) attended and degrees attained, if any.
Including name of employer or company, whether self-employed, job title, period worked.
For example, special awards received, leadership positions held.
Is there anything else you would like us to know for the purposes of this project?