Collecting Memories

As you work through the questions below, be truthful - be authentic - don't leave anything out that will help us get to know the one you knew so well. Please remember that we can only know your loved one by what you tell us. The boxes will expand to accommodate all you want to say. If some questions don't apply or you don't feel comfortable sharing, feel free to leave them blank.

The best eulogies include stories of your loved one. We're going to ask you to provide three. These do not need to be full blown stories. Just give the details. We'll take care of the rest - but DO include at least the three we request, if not more. There is an * on the story questions, requiring that something be included in the box.

If you close this tab before submitting the questionnaire,
your work will be lost! It WILL NOT be saved.

As an alternative, you may want to complete the questionnaire offline. In so doing you retain your responses and can resend if we, for some reason, do not receive the questionnaire (this online questionnaire has been a bit glitchy of late, so we strongly suggest you take the offline completion option).

Click HERE to copy and paste the questionnaire into the body of an email for completion offline.
This is the preferred method, in that there is no danger of losing your work.
Please send the email to Steve at [email protected]

The Essentials

* Indicates required field

Your Loved One's Name *

First

Last

Your Name *

First

Last

Phone Number *

Your Email Address *

A eulogy often begins by thanking people for coming and for the words of sympathy and encouragement that have been sent in cards or emails. Would you like the eulogy to begin with a ‘thank you’ statement? *

He/She is my (relationship) *

Did he/she have a Nickname?Untitled *

What did YOU call him/her? *

When will the funeral or memorial service be held? *

What is the name of the Funeral Home? *

About Your Loved One

Boxes will expand to accommodate as much as you want to say.

What was his/her age? *

If married, spouses name. How long were they married? Is the spouse living? *

Describe their relationship. Choose two or three of the following and tell how they apply to the marriage relationship as you saw it: Mutual Admiration And Respect, Affection, Commitment, Communication, Companionship, Mutual Support, Loving, Helper, Soul Mate, Inspiration to others: *

Had he/she been ill for a while or did he/she die suddenly? *

Was he/she living independently or in a nursing/rehab facility? *

What education level did he/she reach? If college, what did he/she major in? *

Did he/she have any obstacles to overcome in his/her life? *

What did he/she do for a living? For what company? For how long? Had he/she retired? Did he/she enjoy their work? *

What are some things he/she enjoyed doing? Choose one or two of the following (or something else) and TELL A STORY: Reading , Shopping , Singing, Listening to music, Going to the theatre , Dancing , Scrapbooking , Genealogy , Hiking , Biking , Board games , Swimming , Surfing the web , Writing , Watching movies , Going for walks , Going to the beach , Visiting museums and art galleries , Lunch with friends , Playing a musical instrument. *

Was he/she a religious person? If so, to what extent? Did he/she have a church or synagogue or mosque? Is there a passage of sacred writing that you would like to have used in the eulogy? *

Who were his/her closest friends? How did they meet? What did they enjoy doing together? *

Is there some phrase or words he/she always used - some expression uniquely his/hers? What did it mean? *

Did he/she have any pets? If so, please describe them. *

How do you think he/she most influenced the lives of those he/she knew? *

Anything else you think we should know about your loved one *

Children's Names Are the children adults or children? Are they all living? *

Did he/she have grandchildren and/or great grandchildren? *

Describe his/her relationship with the grandchildren. Choose two or three of the following words and tell how they apply - or TELL A STORY that shows the relationship: Patient, Fun, Always there, Empathetic, Supportive, Flexible, Encouraging, Willing listener, Fairness, Unconditional love, Responsiveness, Good Role Model *

What stories of his/her childhood did he/she tell? *

Any stories about teen and young adult years? *

Did he/she ever serve in the military? Which branch? Any stories you recall? *

Choose at least one of the following characteristics and TELL A STORY about your loved one: Adaptable, Compassionate, Confident, Creative, Emotional, Empathetic, Forgiving, Generous, Honest, Kind, Natural Leader, Loyal, Open-minded, Patient, Perseverante, Positive, Problem-solver, Reliable, Resilient, Respectful, Self-aware, Self-disciplined, Self-motivated, Funny, Hard working, Outgoingitled *

What do you think he/she would say were the biggest achievements of his/her life (other than having and raising family)? *

What do you think he/she was most grateful for in life? *

What would you say might have been the greatest day or days of his/her life (other than children being born)? *

What trait or characteristic or value do you think he or she would most like to have passed on to the next generations? *

Did he/she enjoy music? What kind? Any favorite songs? *

A eulogy typically ends with a final thought or message to your loved one, talking about the impact they had on others and on you. What should that statement include. *

Submit

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