The 100 Project | Centenarian Application

Centenarian Application

Thank you for your interest in sharing a centenarian’s story with The 100 Project.

This form gives you the opportunity to tell us about the centenarian, why their life story should be considered for inclusion, and who will be responsible for filming them.

Centenarian Information

Full Name of Centenarian:* Age:* Town / State:*

Primary Contact

Full Name:* Relationship to the centenarian:* Phone Number:* Email Address:* Town / State:*

Has the Centenarian Agreed?

Have you spoken to the centenarian about being interviewed and filmed for The 100 Project?* Yes - they are happy to participateYes - they are interested but would like to discuss it furtherNot yet If there is anything we should know about the centenarian's willingness or ability to participate, please tell us here:

Filming the Centenarian

If your nomination is accepted, we will generally ask you or someone close to the centenarian to interview and film them using a smartphone.

Who will be responsible for interviewing and filming the centenarian?* I willA family member or someone else close to the centenarian willI'm not sure yetWe are unable to film and interview the centenarian and would like The 100 Project to consider doing this

If a family member or someone else will be doing the filming, please tell us who:

Name: Relationship to the centenarian: Have you discussed the filming with the person who will be doing it?* Yes - we have discussed it and they are happy to do itNot yet - I need to discuss it with themNot applicable - I will be doing it myselfNot applicable - We are asking The 100 Project to consider doing it When do you think you would realistically be able to film the centenarian if your nomination is accepted?* Within the next monthWithin 1-3 monthsMore than 3 months from nowI'm not sure

Tell Us About the Centenarian

What makes their life story compelling? What major events, achievements, challenges or historical moments have shaped their life?*

Why Do You Want This Story Told?

What would it mean to you, your family, or the broader community to have this story preserved?*

Photos & Archival Material

Do you have photographs of the centenarian from earlier in their life?* YesNoUnsure If yes, please describe the types of photos available (e.g. childhood, parents, wartime service, family life, career, migration, special events):

Follow-Up Contact

May we contact you after reviewing this submission?* YesNo Preferred contact time: