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Interviewee Name:
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Interviewee Country of Origin:
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Interviewee Date of Birth:
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Preferred Language:
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Brief Summary of Experience:
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Contact Person 1 (Please put your contact information unless you would like someone else to be the primary contact):
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Contact Person 1 Relationship to Interviewee:
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Contact Person 1 Email:
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Contact Person 1 Phone Number
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Contact Person 2:
Contact Person 2 Relationship to Interviewee:
Contact Person 2 Email:
Contact Person 2 Phone Number:
Current physical address of Interviewee:
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Have you given testimony before?
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Yes
No
If yes, where and when?
Would you prefer to have your testimony recorded in person or virtually?
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Thank you! After you submit this form, a USC Shoah Foundation staff member will reach out to you within three weeks. If you have not heard back after this time, please contact Moira at mh_884@usc.edu.
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