| Birth and Childhood |
| What is your full name? * |
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| What is your date of birth? |
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| In what city, county, state and country were you born? |
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| How do you fit in the birth order of your family? |
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| What were you like as a child? |
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| Did you have a favorite pet, toy, or activity that you enjoyed? |
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| What memory about your family, your house or a friend stands out? |
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| Anything else you'd like to share? |
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| Education |
| What schools did you go to? |
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| What teacher had the greatest impact on your life and why? |
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| What was your favorite subject? |
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| What memory about school stands out? |
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| What extra curricular activities did you enjoy? |
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| Military |
| If you served in the military, what branch did you serve in? |
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| What were some of the specifics about your service - were you drafted or did you enlist, did you serve during wartime, where were you stationed, were you ever in combat, were you ever wounded, what medals did you receive for your service, etc.? |
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| What are some of the things that you remember or find most interesting about your time in the military? |
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| Career |
| What was your first job? |
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| What other jobs did you have? |
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| What were the greatest achievements in your career? |
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| Who or what do you think most influenced your career? |
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| Love and Marriage |
| How and when did you meet your spouse? |
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| Where did you go on your first date? |
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| How much did the date cost? |
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| What was your favorite song as a couple? |
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| How did you know that they were the one for you? |
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| How did you propose to your spouse/did your spouse propose to you? |
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| Where did you have your wedding? |
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| What is your most special memory of your wedding day? |
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| How long were you married? |
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| Parenthood |
| How many children did you have? |
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| What memories do you have of their childhood? |
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| How did you celebrate their birthdays? |
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| What family activities did you enjoy? |
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| Where would your family go on vacation? |
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| What were your proudest moments as a parent? |
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| Middle Age |
| Where did you and your spouse reside? |
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| What were the important things in your life at this time? |
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| What kinds of activities did you and your spouse enjoy? |
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| What did you like best about this time in your life? |
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| Mature Age |
| What interests or hobbies did you enjoy during retirement? |
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| What do you think are the best parts of being a senior citizen? |
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| What do you enjoy most about having grandchildren? |
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| What wisdom would you like to share with others? |
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| What are you most proud of in your life? |
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| Personal Thoughts |
| Who is the wisest person you have met in your lifetime and why? |
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| What was the best decision that you made during your lifetime? |
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| If you could have dinner with any two people, living at any time during history, who would they be and why? |
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| What are the most important things that you would want others to know about you? |
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| Resident Info |
| Resident's Facility * |
Traditional Living
Skilled Care
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| Resident's Room Number * |
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| Resident's Representative * |
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* I give permission for Resident's biography information to be used within The Villages of Wilkes community for staff education and to highlight their life.
By checking the box, you agree to the release above.
This form, indicating your release of photos will be kept on file at The Villages of Wilkes.
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