History Makers Workshop: Tell Your Story Application
Apply to be have your story included in Our Genetic Legacy's new American history book.
Your Name
*
First Name
Last Name
Birthdate
*
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Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Include ext.
E-mail
*
Race or Ethnicity
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American Indian or Alaskan Native
Asian or Pacific Islander
Black or African American
Hispanic or Latino
White/Caucasian
Other
How did you hear about this project?
*
Include ext.
Have you DNA tested?
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Yes
No
If so, with whom? Check all that apply.
23 & Me
African Ancestry
Ancestry
FamilyTreee DNA
My Heritage
Other
Has anyone else in your family DNA tested?
*
Yes
No
Don't Know
If so, with whom? Check all that apply.
23 & Me
African Ancestry
Ancestry
FamilyTreee DNA
My Heritage
Other
Are you adopted?
*
Yes
No
Do you know the name of your biological mother?
*
Yes
No
Do you know the name of your biological father?
*
Yes
No
Do you know the name(s) of your paternal grandparents?
*
Yes
No
Do you know the name(s) of your maternal grandparents?
*
Yes
No
Where do you think your family legacy begins?
*
What does legacy mean to you?
*
Please be specific and add directions if it is difficult to find.
Why do you want to include your story in this new American history book?
*
For full release to Our Genetic Legacy for use of your photos, please select the top option:
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I hereby grant Our Genetic Legacy Inc. the right to record and use all digital media and/or reproductions from this application process for display, publication, related website and blog use, contest entry, and/or peer review. I understand that although I retain full rights to my original documents, I give Our Genetic Legacy Inc. the irrevocable right to use all of the findings related to this process as they see fit.
Photo of Applicant
*
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Upload a photo that represents legacy to you.
*
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Thank-you for applying, we'll be in touch if your application is chosen!
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