Story Teller's Form


Contact Information

First Name  
Last Name  
Maiden Name
Address  
City  
State
Daytime Phone
Cell Phone
Email  
Prefered Contact Method  

Interview Information

Please describe (100 words or less) the story you would like to tell-
(Include approximate dates/years, location, and any other details)


Do you have any artifacts (pictures, plaques, trophies, etc.) that you
would like to present during the storytelling time? These items will be
photographed during the interview. Please indicate.


Please indicate days/times you are available to travel to the North
Idaho College Coeur d’Alene campus to tell your story.

Weekdays

Time Blocks