Verona Public Library 500 Silent Street Verona, WI 53593 (608) 845-7180 www.musicandmemory.org www.veronapubliclibrary.org
Playlist Questionnaire iPod© User’s Name: Requester name: Requester e-mail: Requester daytime phone: Library card:
Interview questions for the iPod User
Where did you grow up? Native language Do you have older brothers and/or sisters? If yes, did you listen to their music? What music did your parents listen to? Where did you attend college? Degree: What was your profession/career? Please list hobbies/areas of interest (i.e. gardening, woodworking, sports, bird watching, art, etc.):
What is your favorite T.V. show? Your favorite movie? What is your favorite type of music? Who is your favorite performer, group, band, orchestra? Did/do you sing at religious services? If so, what denomination and what part of the country?
Favorite hymns or other religious music? Which Broadway shows or musicals do you enjoy? Which live music performance/concert was your favorite? Do/did you like to dance? If so, what type? Salsa Ballroom Swing Disco Square dance Polka Ballet Line Do/did you play an instrument and if so, which one? Do you have a favorite classical music composer? What songs did you dance to at your wedding? High school prom? Were you in the armed services? If so, what branch, where and when did you serve? If you traveled, where did you travel and what was your favorite place to visit? iPod© User’s Musical Preferences (check all that apply)
Easy Listening Broadway Musicals Country Oldies Classical __ Burt Bacharach __ A Chorus Line __ Johnny Cash __ Bach __ Tony Bennett __ Annie __ Patsy Cline __ Beethoven __ Glen Campbell __ Anything Goes __ John Denver __ Brahms __ Carpenters __ Cabaret __ Vince Gill __ Chopin __ Rosemary Clooney __ Camelot __ Merle Haggard __ Debussy __ Nat King Cole __ Carousel __ George Jones __ Dvorak __ Neil Diamond __ Cats __ Loretta Lynne __ Handel __ The Four Lads __ Chicago __ Willie Nelson __ Haydn __ Engelbert __ Gypsy __ Dolly Parton __ Liszt Humperdinck __ Hello Dolly __ Charlie Rich __ Mendelssohn __ Peggy Lee __ Les Miserables __ Kenny Rogers __ Mozart __ Liberace __ Lion King __ Conway Twitty __ Satie __ Barry Manilow __ Mary Poppins __ Hank Williams __ Schubert __ Montovani __ The Music Man __ Tammy Wynette __ Schumann __ Anne Murray __ My Fair Lady __ Segovia __ Les Paul & Mary Ford __ Oklahoma R&B/Soul/Motown __ Shostakovich __ Frank Sinatra __ Phantom of the Opera __ James Brown __ Stravinsky __ Barbara Streisand __ Sound of Music __ Mariah Carey __ Tchaikovsky __ Andy Williams __ South Pacific __ Ray Charles __ Verdi __ Sunset Boulevard __ Sam Cooke __ Vivaldi Country Contemporary __ West Side Story __ Fats Domino Blues __ Alabama __ Aretha Franklin __ John Lee Hooker __ Clint Black Big Band/Swing __ Marvin Gaye __ BB King __ Garth Brooks __ Andrews Sisters __ Michael Jackson __ Blues Traveler __ Johnny Cash __ Count Basie __ Jackson 5 __ Stevie Ray Vaughan __ Kenny Chesney __ Les Brown __ Alicia Keys __ T Bone Walker __ Dixie Chicks __ Tommy Dorsey __ Aaron Neville __ Muddy Waters __ Patsy Cline __ Eddy Duchin __ The O’Jays Latino/Spanish __ Eagles __ Billy Eckstine __ Otis Redding __ Celia Cruz __ Merle Haggard __ Duke Ellington __ Lionel Richie __ Gloria Estefan __ Toby Keith __ Benny Goodman __ Smokey Robinson __ Graciela Beltran __ Tim McGraw __ Woody Herman __ Diana Ross __ Jose Carreras __ Willie Nelson __ Guy Lombardo __ The Stylistics __ Juan Gabriel __ Brad Paisley __ Glenn Miller __ Donna Summer __ Marc Anthony __ Dolly Parton __ Artie Shaw __ The Temptations __ Placido Domingo __ Lee Ann Rimes __ Four Tops __ Tito Rojas __ Kenny Rogers Folk __ Luther Vandross __ Victor Manuelle __ Blake Shelton __ Joan Baez __ Stevie Wonder __ Vicente Fernandez __ Shania Twain __ Bob Dylan __ Barry White 20’s/30’s __ Carrie Underwood __ Judy Collins __ George Gershwin __ Dwight Yoakam __ Scott Mackenzie TV Show themes __ Ethel Merman __ Joni Mitchell __ MASH __ Cole Porter Patriotic __ Laura Nyro __ Odd Couple Holiday __ My Country tis of thee __ Mamas & Papas __ Dragnet __ Bing Crosby __ Home on the Range __ Melanie __ I Love Lucy __ Nat King Cole __ America the Beautiful __ Peter, Paul and Mary __ Honeymooners __ Instrumental __ Star Spangled Banner
Music & Memory: Library based program Form#______
Library name: ______
Demographic Information
Individual the personalized playlist was created for
☐ Male ☐ Female
Age: ☐ Over 60 ☐ Under 60
Ethnicity: ☐ Hispanic or Latino ☐ Non-Hispanic
Race: ☐ White-non-Hispanic ☐ White-Hispanic ☐ Indian American ☐ Asian
☐ Black or African American ☐ Two or more races ☐ Other, non-specified
Veteran Status: ☐ Yes ☐ No
Primary caregiver of the individual provided the personalized playlist
☐ Male ☐ Female
Age: ☐ Over 60 ☐ Under 60
Ethnicity: ☐ Hispanic or Latino ☐ Non-Hispanic
Race: ☐ White-non-Hispanic ☐ White-Hispanic ☐ Indian American ☐ Asian
☐ Black or African American ☐ Two or more races ☐ Other, non-specified
Veteran Status: ☐ Yes ☐ No
This program is made possible by grant# 90DS2020 from the Administration on Community Living. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the US Dept of Health and Human Services, Administration on Community Living. March 2017