Pre-Interview Questionnaire -

We are excited about your interview on the Brainy Moms podcast! Please take a few minutes to complete this pre-interview questionnaire to help us plan your episode.

Name *

First

Last

Email *

How would you like to be introduced? *

Name and credentials along with your profession/job title...not a full bio. We'll ask for that in a minute! (i.e. Cognitive Psychologist Dr. Amy Moore)

What name would you like us to call you through your interview? *

i.e. Dr. Amy, Dr. Moore, Amy, etc?

How do you pronounce your name?

We don't want to say it incorrectly. So, please help us out with an illustration if your name is any harder than Moore or Smith or Jones. (i.e. rhymes with or the phonetic spelling.)

Please write a 2-3 sentence bio for us to use in crafting your introduction: *

Please give us a list of 3-5 talking points you want to cover during the interview. You can list these as “main ideas” or as specific questions you’d like to answer. We'd love it if you give us some detail here. It truly helps us design an interview tailored just for you! *

Name of book, podcast, service, or product you'd like to talk about and promote during your interview: (if applicable)

Your website:

Your social media handles (for tagging you in promotion of your episode):

Facebook, Instagram, Twitter, etc.

Optional special offers for listeners:

Some guests give freebies, downloadable content, or discount codes to listeners. If you want to do that, please describe any special offers you want us to promote.

If you haven't already sent us your headshot or photo, please upload it now so we can include it in your episode artwork and social media promotion.

Click or drag files to this area to upload. You can upload up to 3 files.

Optional: If you'd like to give us your media kit or other promotional materials, here's the spot to upload those!

Click or drag files to this area to upload. You can upload up to 4 files.

Permissions and Clarifications: Please check the boxes below indicating that you have read and agree to the statements next to them. *

I agree to have my interview recorded and released as an episode (regular and/or special) of the Brainy Moms podcast.
I understand that audio, video, and written versions of my interview may be published.
I understand that I won't be paid for my appearance on Brainy Moms.
I give Brainy Moms permission to promote my episode.
I understand that the Brainy Moms team would appreciate it if I would share my episode with my tribe.

Oh, one more thing before you go…At the end of your interview if we have extra time, we may ask you some personal questions about going back in time as a parent and doing things differently, or what advice you would give to your younger self, or sharing your favorite product or indulgence with our listeners.

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