One Small Step Questionnaire – WDC

Name*
First Last
Location (City, State, ZIP)*
City State ZIP Code
Email Address*
Preferred phone number*
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.
- Radio
- Social media
- Email
- Flyer, postcard, or other print advertisement
- Event
- A friend, family member, or colleague
- A group or organization
- Another way
Hidden
How 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
Please specify
Terrific! Can you share their name?
Great! Which one?
Tell us more!
Do 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.
Currently, conversations are hosted virtually, but we may conduct recordings in person later this year. How would you prefer to participate?
- Virtually
- In-person
- No preference (comfortable with either)
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.

Introduce Yourself*
If you’re chosen to participate, we’ll share what you write below with your conversation partner a few days before you meet. Write a few details that give a sense of who you are, where you're from, the big life events that shaped you (e.g. the birth of children, or losing a loved one), and any issues that are especially important to you.

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