45 Questionnaire Template

This is an optional template to use for your team-created questionnaire. Once you have determined who you will be interviewing, please use this or a similar interviewer tool in conjunction with an empathy map for recording observations during the interview:

Interviewee’s name or pseudonym for privacy (this person MUST be real though):

Demographic info–choose whatever might be relevant to your issue (age, hometown, profession/job position, race/ethnicity, marital status, religion, etc.)

Their hometown/country:

Date/time of interview:

Location of or medium (in-person, phone, text, email, Facetime/Skype, social media app, etc.) for interview:

Please remind the interviewee that 1) they only have to answer questions they are comfortable with. We don’t want to cause folks anxiety or additional trauma. 2) You can and will protect their identity if they prefer to remain anonymous. And 3) their responses will be used to write a Profile essay and shared with team members to write the Synthesis essay.

Please thank this person for their time!