Life Story Video Survey Form
Please complete this survey to help us create a meaningful and personalized life story video. All questions are designed to capture your unique experiences and preferences.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Preferred Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Which major life themes or milestones would you like to highlight?
*
Childhood
Family & Relationships
Education
Career & Achievements
Personal Challenges
Hobbies & Passions
Travel & Adventures
Other
How would you describe your personality or the tone you want in your video?
*
Uplifting and Positive
Reflective and Thoughtful
Humorous and Lighthearted
Inspirational
Other
How comfortable are you sharing personal stories on camera?
*
Not comfortable
1
2
3
4
Very comfortable
5
1 is Not comfortable, 5 is Very comfortable
Please share a brief summary of your life story or any key moments you want included.
*
Preferred video length
Up to 5 minutes
5–10 minutes
10–20 minutes
Other
Upload a photo or file (optional, for reference or inclusion in your video)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
How important is it for your video to include input from friends or family?
Not important
1
2
3
4
Very important
5
1 is Not important, 5 is Very important
Submit Survey
Should be Empty: