Dating IRL Podcast Interview Intake Form

Podcast Interview Intake Form

I'm so excited you're interested in joining us on The Dating IRL Podcast! Below are some questions to help us get a better idea of who you are, what you'd like to talk about, and what you're comfortable with. We will be in contact soon! Thanks so much!
Name

First Name Last Name
Nickname to be addressed in podcast
Email
example@example.com
Phone Number
Please enter a valid phone number.
City, State
Age
Gender

Male Female Transgender Non-binary Prefer not to answer
Sexuality

Heterosexual Homosexual Multisexual (bigger umbrella than bi-sexual) Prefer not to answer
Race

Hispanic Asian Black/African American White American Indian/Alaskan Native Indian Prefer not to answer Other
Relationship Status

Divorced Widowed Single Married/ENM Prefer not to answer
Which question would you like to focus your interview around?

What misconceptions of love, sex, and relationships did you grew up with and how did they play a role in your life as an adult? What were the moments in your life that you experienced the beauty of real connection with someone else or a community? What have been the hardest realizations to acknowledge and accept about yourself? How have you worked on these aspects yourself? What does your best life look like? What do you have already and what do you still need to self-actualize? Other
Any particular topic/experience you'd like to discuss? (I don't need all the details but if you had an idea you can include it here.)
Any potential triggers that you're planning on sharing in your interview?

Abuse Mental Health Substance Abuse Death Violence Other
Anything I should know ahead of time about the above?
Are there any topics that are 'off the table'? I'll make sure to steer clear of them!
Pick 3 "random" questions to be asked on the podcast.

Favorite way to spend a Saturday afternoon? Best meal you make at home? Cats? Dogs? Both? Neither? Top 5 values that drive your choices? How would your friends describe you? What relationship skills come easily to you? Which ones do you have to work on? What are you reading right now? Which movie/music/tv show has influenced you the most?
Ideal Date/Time (Not Official Time! Larissa will contact you to confirm)
Signature

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