OSS Connect Survey Form

1Start

2Politics & Beliefs

3Politics & Beliefs

4Politics & Beliefs

5Your Life

6Your Life

7Your Life

8Your Life

9Demographics

10Contact Info

11Confirmation

12Confirmation

13Confirmation

You’ll have your conversation via our One Small Step Connect digital platform. We’ll send you a few matches, you’ll choose who you want to talk to, and then you’ll talk via video call–with help and guidance from us all along the way.

You live in or near a community where one of our radio station partners offers a One Small Step program. Radio station staff will match you with a partner and help you schedule your conversation. Then, a trained facilitator will support you through your conversation recording— either in person or via a video call.

You live in or near a One Small Step Model Community. We’ll match you with a conversation partner and schedule your conversation. Then, a trained StoryCorps Facilitator will support you through your conversation recording— either in person or via a video call.

Let’s sign you up to have a conversation. This will take about 10 minutes. To get started, tell us your email address so that you can come back to this form anytime.

Email Address*

1 Politics & Beliefs

Help us understand your beliefs around politics, religion, and more. This information will be used to match you with others whose beliefs differ from yours.

How often do you engage in conversations with people who have different beliefs than you?*

Often

Sometimes

Rarely

Never

Help us understand your beliefs around politics, religion, and more. This information will be used to match you with others whose beliefs differ from yours.

Where on this scale would you place your thinking on social issues?*

Please enter a number from 1 to 10.

Very Liberal

Very Conservative

I prefer not to place myself on this scale

Briefly describe your thinking on social issues **

Where on this scale would you place your thinking on economic issues?*

Please enter a number from 1 to 10.

Very Liberal

Very Conservative

I prefer not to place myself on this scale

Briefly describe your thinking on economic issues*

How important is religion in your life?*

Please enter a number from 1 to 10.

Not at all

Extremely

I prefer not to place myself on this scale

Briefly describe your thinking on religion*

While we pair strangers with different beliefs, the goal is to remind us that we’re all human and that we have more in common than we think. These questions will help us pair you with others who share similar passions or life experiences.

Are you a registered voter in the US?*

Yes

Prefer not to answer

Which party are you registered with, if any?

Democratic

Republican

Green

American Independent

Libertarian

No party affiliation

Another party

Please specify

2 Your Life

We want to know more about you and your experiences.

Do any of these describe you?

Select as many as you’d like.

Grandparent

Parent

Political

Veteran or from a military family

Active in my community

Outdoorsy

Outgoing

Animal lover

Religious or spiritual

Shy

Tech-savvy

Creative

We want to know more about you and your experiences.

Have you experienced these life events recently?

Select as many as you’d like.

Became a parent

Became a grandparent

Lost a loved one

Moved to a new community

Started a new job

Lost a job

Got married

Got divorced or had a breakup

Fought with family or friends

Another major event

Please describe

We want to know more about you and your experiences.

List up to three additional passions or interests *

Think: hobbies, sports/sports teams, music, movies, talents, etc.

1.*

Your bio will be visible on our digital platform as a way for your partners to know you better.

Take a moment to fill out a short bio and introduce yourself to your partner in your own words. *

Share a few sentences about who you are and your background: family, community, significant life events, personal values, and important issues. Avoid sharing personally identifiable information like your name or employer.

Example: I am the youngest of 6 kids and was raised on a farm in rural California. My faith as a Christian drives my politics. Hunting and fishing are important to me, and I care deeply about public land use and conservation. I have been married for 47 years. I have adult children and 6 grandchildren. I lost one of my children a few years ago.

Take a moment to fill out a short bio and introduce yourself in your own voice.*

3 Demographics

Demographic information is used in our archiving process. This section is optional.

How old are you?*

You must be at least 18 years old.

How old are you?*

Gender

Female / Woman

Male / Man

Another gender identity

Please Specify*

Race or Ethnicity

American Indian / Alaska Native

Asian

Black or African American

Hispanic or Latino/a/x

Native Hawaiian / Pacific Islander

White / Caucasian

Not listed here

Please Specify*

Religious affiliation

Buddhist

Christian

Hindu

Jewish

Muslim

Secular/Atheist/Agnostic

Unitarian Universalists

Not listed here

Please Specify*

4 Contact Info

We’re asking for your phone number in order to connect with you via this method if we need to, in order to provide further support.

Before your interview, we will only share your first name and last initial with your partner.*

First Last

Location (City, State, ZIP)*

City State ZIP Code

Phone*

By providing your phone number, you agree to receive text messages from StoryCorps and One Small Step. Message and data rates may apply. Message frequency varies.

How did you find out about One Small Step?*

I saw an advertisement

I heard about it at an event

I learned about it from a friend, family member, or colleague

I heard about it from a group or an organization I’m a part of

Another way

Tell us more!*

Most One Small Step recordings take place online via a video call. Do you have access to a computer or mobile device (iPad, tablet, etc.) and reliable internet?*

If not, don’t worry! We want to make this opportunity available to everyone, so we will work with you to find another way to participate.

Yes

How do you prefer to participate in a One Small Step conversation?*

We only offer a select number of in-person recordings and it may take longer for those opportunities.

Virtually

In-person

No preference

Your location is based on the ZIP code you entered at the beginning of the form and can’t be edited here.

Last step! Once you submit this form, we will match you with potential conversation partners. The following information will be shared with your potential partners exactly as you have written it here:

Name

Age

From

Social Issues

Liberal

Conservative

Economic Issues

Liberal

Conservative

Religion

Not at all

Extremely

Events

Interests

Bio

Hidden

Email me a copy of my summary page.

I agree to One Small Step's terms and conditions*

I agree to One Small Step’s terms and conditions.

The following information will be shared with potential participants exactly as you submit in this questionnaire: first name, city & state, gender, age range (e.g., 20–30), political party, social issues score, interests, bio, key descriptors and life events.