One Small Step Participant Matching Questionnaire – Library of Virginia One Small Step Participant Matching Questionnaire Thank you for your interest in participating in StoryCorps’ One Small Step initiative (OSS) initiative. We use this questionnaire to match you with a conversation partner—someone we think you’ll connect with, even though you may have different beliefs. The form typically takes applicants about 5-7 minutes to complete. IMPORTANT: The information you share in this form will be used by StoryCorps to match you with a conversation partner and to personalize email content for you. Shortly before your interview, we’ll share your first name, last initial, and a short bio with your conversation partner. Let’s get started!Name* First Last Location (City, State, ZIP)* City ALAKASAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPAPRRISCSDTNTXUTVIVTVAWAWVWIWYAAAEAP State ZIP Code Email Address* Preferred phone number*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.If you are a member of the college community, are you a…? Student Faculty member Alumni College administrator How did you find out about the opportunity to participate in StoryCorps' One Small Step?*Please check all that apply. I saw an advertisement (Facebook ad, radio ad, door hanger, poster, etc.) 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 HiddenHow did you find out about the opportunity to participate in StoryCorps' One Small Step? Radio Social media Email Flyer, postcard, or other print advertisement Event A friend, family member, or colleague A group or organization Another way Great! Which one? Terrific! Can you share their name? Great! What was the event? Tell us more! HiddenDo you know someone you would like to speak with for One Small Step?If you have a conversation partner in mind, we will get in touch with you for further details. No Yes Person's name, and relationship to you 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?* Yes No 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. How do you prefer to participate in a One Small Step conversation?VirtuallyIn-personNo preferenceHow often do you engage in conversations with people who have different beliefs than you? Often Sometimes Rarely Never Now, help us understand your political beliefs:HiddenDo you have access to a computer or mobile device (iPad, tablet, etc.) and reliable internet? Yes No 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.Where on this scale would you place your thinking on social issues? *Drag the slider to where you see yourself on the scale, with the left being the most liberal and the right the most 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? *Drag the slider to where you see yourself on the scale, with the left being the most liberal and the right the most conservative. I prefer not to place myself on this scale.Briefly describe your thinking on economic issues. How important is religion in your life? *Drag the slider to where your feelings on religion fit best on the scale, with the left being not at all important and the right extremely important.I prefer not to place myself on this scale. I prefer not to place myself on this scale Briefly describe the role of religion in your life. Are you a registered voter in the US?* Yes No Prefer not to answer Which party are you registered with, if any? Democratic Republican Green American Independent Libertarian No party affiliation/independent Another party Please specify WHILE ONE SMALL STEP PAIRS 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. THE BEST INTERVIEW PARTNERS OFTEN SHARE A PASSION OR SIMILAR LIFE EXPERIENCES. THE FOLLOWING QUESTIONS WILL HELP US IN THE PAIRING PROCESS.Do any of these describe you?Please select as many as you like. Grandparent Parent Political Veteran / From military family Active in my community Outdoorsy / Nature lover Outgoing Animal lover Religious / Spiritual Shy Tech-savvy Creative Have you experienced any of these life events recently?Please select as many as you like. Became a parent Became a grandparent Lost a loved one Moved to a new community Started a new job Lost a job Health or health of a loved one impacted by COVID-19 Got married Got divorced / Had a breakup Fought with family or friends over politics Another major event Please describe List up to three (3) additional passions or interests (i.e., hobbies, sports/sports teams, music etc.)PROVIDING STORYCORPS WITH THE DEMOGRAPHIC INFORMATION WE ASK FOR BELOW IS OPTIONAL. HAVING MORE INFORMATION ABOUT YOU WILL HELP US MATCH YOU WITH AN INTERVIEW PARTNER, SO WE ENCOURAGE YOU TO PROVIDE AS MUCH INFORMATION AS MAKES YOU COMFORTABLE.Introduce Yourself*Provide a short biography below (a maximum of 500 characters). Good bios tell your partner about who you are and where you’re from: the family you grew up in, your community, big life events that have shaped you, your personal values and any issues that are especially important to you. If you opt-in to the OSS Connect experience (see below), exactly what you write here will be shared with a number of potential partners. Be careful not to include any personally identifiable information like your full name, employer, etc. If you chose only the One Small Step facilitated conversation, only your partner will see your bio. This bio will be read aloud as part of your recorded conversation. If you opt-in to the OSS Connect experience (see below), exactly what you write here will be shared with a number of potential partners. Here’s an example to guide you. “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.”AgeGender Female / Woman Male / Man Another gender identity Please specify Race / Ethnicity American Indian or Alaska Native Asian Black or African American Hispanic or Latino/a/x Native Hawaiian or Pacific Islander White/Caucasian Not listed above Please specify Religious affiliation Buddhist Christian Hindu Jewish Muslim Secular/Atheist/Agnostic Unitarian Universalist Not listed above Please specify NEW! One Small Step Connect This fall, StoryCorps will offer a new way to have an OSS conversation. OSS Connect allows you to engage in a virtual One Small Step video conversation—without a facilitator. Don’t worry, we will provide you with tools to support your experience every step of the way and rest assured we will only record the audio of your conversation. Learn more about the difference between the facilitated and unfacilitated OSS experience in our FAQ. Opting into the OSS Connect experience does not remove you from consideration for a facilitated interview—we’d love for you to experience a conversation both ways. And, you can do as many OSS Connect conversations as you’d like. IMPORTANT:If you opt into the OSS Connect experience, we may share some or all of the following information with other potential participants, who you may or may not end up connecting with for a conversation. This information will be shared exactly as you complete it here: first name and last initial; city & state; gender; age range (i.e., 20–30); political party; social issues score; interests; bio; key words from “descriptors” and life events. Opt-In* Yes, please consider me for the One Small Step Connect virtual experience. No thanks, I don’t want to be considered for the One Small Step Connect virtual experience at this time. THANK YOU FOR COMPLETING THIS QUESTIONNAIRE. OUR TEAM WILL NOW BEGIN LOOKING FOR YOUR MATCH. IF WE ARE ABLE TO MATCH YOU, A STORYCORPS TEAM MEMBER WILL REACH OUT TO SCHEDULE YOUR INTERVIEW AND PREPARE YOU FOR THE CONVERSATION.