The Quilt
Research Questionnaire One
I have put this questionnaire together to gather information on the 24 ladies who participated in the making of “the Quilt.” Filling out this form is purely voluntary. I will not give out your personal information without receiving specific permission from you. The information given will be used solely to write the book. At this point I am looking for the following information. Future questionnaires may be more specific depending on the information I receive here. I feel it is so important to preserve, not only the artifacts, but also the stories behind them. Thank you, in advance for your cooperation. I am really looking forward to hearing/reading about your relatives.
Circle the names of the Quilters you know or have information about:
Mae Stoneman, Carol Schmitz, Beulah Weber,
Jean Stoneman, Harriet Perry, Lorraine Faken,
Rita Cumber, Florence Wiese, Rosabelle Englebert,
June Weber, Ione Schmitz, Phyllis Brandt,
Jean Stoneman, Harriet Perry, Lorraine Faken,
Rita Cumber, Florence Wiese, Rosabelle Englebert,
June Weber, Ione Schmitz, Phyllis Brandt,
Doris Schmitz, Martha E. Perry, Eileen Perry,
Jeanette Hirschboeck, Gladys Perry, Marie Bretl,
Helen Rose, Gertrude Feld, Eileen Baumann,
Patsy Stoneman, Marjory Peterson, Virginia Bretl.
Jeanette Hirschboeck, Gladys Perry, Marie Bretl,
Helen Rose, Gertrude Feld, Eileen Baumann,
Patsy Stoneman, Marjory Peterson, Virginia Bretl.
I have enclosed a Personal Information form that can be used to collect information that pertains to specific individuals. All forms can be copied. Please fill out as many forms as you have names circled above. If you know anyone who may have more information on any of the ladies listed above, please forward a copy of this letter and its contents.
Send completed forms to:
Anne E. Mueller
652 HWY 42 S
Sturgeon Bay, WI 54235
My email address is: mmueller6369@yahoo.com
Send completed forms to:
Anne E. Mueller
652 HWY 42 S
Sturgeon Bay, WI 54235
My email address is: mmueller6369@yahoo.com
Research Questionnaire One (Cont’d)
Personal Information Form
Your Name: ______________________________________________
Your Address: ____________________________________________
Your Phone Number (with area code): __________________________
Your Email Address: _______________________________________
What way to you prefer to be contacted if necessary?
MAIL PHONE E-MAIL
Would you be willing to participate in an interview? YES NO
If yes, may I have your permission to record the interview?
AUDIO ONLY VIDEO
Your Name: ______________________________________________
Name of Quilter: __________________________________________
Your relationship to Quilter: __________________________________
Quilter Information:
Nickname: ______________________________________________
Maiden Name: ___________________________________________
Married Name: ___________________________________________
Married Name: ___________________________________________
Date of Birth: ___________________ Date of Death: _________
Place of Birth: __________________ Burial Place: ______________
Research Questionnaire One (Cont’d)
Date Married: ________________ Highest completed grade: ______
Name of Spouse(s): ______________________________________
Where did the quilter live in the Forestville Area (address if possible): _____________________________________________________
Last known address: _____________________________________
Children’s names: __________________ ________________
__________________ ______________________ _______________________
__________________ _______________________ _______________________
Quilter’s Employment: _____________________________________
Quilter’s Hobbies: ________________________________________
Quilter’s other interests: ____________________________________
How is the Quilter related to other quilters on the list: _______________
Research Questionnaire One (Cont’d)
Did you ever hear of this quilt before 2011? YES NO
If yes, could you please tell me what you have heard?
Please share one story about the Quilter.
