Individual Input Questionaire

Most of the information presented on this Web site was collected by our ancestors during the end of the 1800s and early 1900s. They lived close enough to visit each other in person from time to time. It has become difficult to maintain contact with other family members since then. Today the Internet is a new and exciting place to, find other people with common interests, and conveniently exchange information. With this Web site relatives, who may not have known the existence of each other, can discover interesting facts about their ancestors. The purpose of this questionnaire is to share information that will be included on this Web site, and eventually in a family history book as a permanent reference source.

Along with the ease of exchanging information on the Internet is the responsibility to protect an individual's privacy. Depending on their personal situation there may be some information which should not be accessed by just anyone on the Internet. As a minimum level of privacy dates and places are limited to the year and state name respectively on this Web site, for people who are alive. With this in mind please use the check boxes (Restrict from Web site) on this form to indicated which items you believe should NOT be presented on the Internet.

Birth:

• Name: (First, Middle, Last)
• Nick Name:Restrict from Web site.
• Sex:
• Girl: Boy:
• Date: (Month, Day and Year, e.g., Jan. 15, 1846) Restrict from Web site.
• Address: (Street Address or Hospital)Restrict from Web site.
• Place: (City, State or Country)Restrict from Web site.
• Father: (First, Middle, and Last Name)
• Mother: (First, Middle, and Maiden Name)

1st - College or University:Restrict from Web site.

• Institution: (Name of College or University)
• Place: (City, State or Country)
• Start Date: (Month, Day and Year, e.g., Aug. 18, 1866)
• Finish Date:(Month, Day and Year, e.g., Jun. 27, 1870)
• Degree:

2nd - College or University:Restrict from Web site.

• Institution: (Name of College or University)
• Place: (City, State or Country)
• Start Date: (Month, Day and Year, e.g., Aug. 18, 1866)
• Finish Date: (Month, Day and Year, e.g., Jun. 27, 1870)
• Degree:

Military:

• Branch: (Name)
• Start Date: (Month, Day and Year, e.g., Aug. 18, 1866)
• Finish Date: (Month, Day and Year, e.g., Jun. 27, 1870)
• Final Rank:

1st - Marriage:

• Name: (First, Middle, Last)Restrict from Web site.
• Date: (Month, Day and Year, e.g., Jun. 27, 1870) Restrict from Web site.
• Place: (City, State or Country) Restrict from Web site.

2nd - Marriage:

• Name: (First, Middle, Last)Restrict from Web site.
• Date: (Month, Day and Year, e.g., Jun. 27, 1870) Restrict from Web site.
• Place: (City, State or Country) Restrict from Web site.

3rd - Marriage:

• Name:(First, Middle, Last)Restrict from Web site.
• Date: (Month, Day and Year, e.g., Jun. 27, 1870) Restrict from Web site.
• Place: (City, State or Country) Restrict from Web site.

4th - Marriage:

• Name: (First, Middle, Last)Restrict from Web site.
• Date: (Month, Day and Year, e.g., Jun. 27, 1870) Restrict from Web site.
• Place: (City, State or Country) Restrict from Web site.

1st - Residence:

• Date: (Month, Day and Year, e.g., Jun. 27, 1870)
• Address: (Street Address)
• Place: (City, State or Country)
• Moved to: Living at:

Residence - 2nd:

• Date: (Month, Day and Year, e.g., Jun. 27, 1870)
• Address: (Street Address)
• Place: (City, State or Country)
• Moved to: Living at:

Residence - 3rd:

• Date: (Month, Day and Year, e.g., Jun. 27, 1870)
• Address: (Street Address)
• Place: (City, State or Country)
• Moved to: Living at:

Death:

• Date: (Month, Day and Year, e.g., Jun. 27, 1870)
• Place: (City, State or Country)
• Cause:
• Cemetery Name:
• Cemetery Place: (City, State or Country)

Biography:

Occupation(s), place(s) worked, and positions(s) held. Other schools, marriage(s), and residence(s). Public service performed. Furnish dates and places to this information.

Sent by:

• Name: (This will be used in the reference source citation)
• Would you like to be notified when this data has been added to the Web site?Yes -No
• E-mail Address: (Required)

Contact duckbill@netwiz.net with questions or comments.