Oral History Informed Consent Form (Sample) [Name of project and/or organizations involved in this project]
You are being asked to participate in an interview in connection with the [Project Name] Oral History Project. You are being asked to participate because [give reason or how selection was made]. You will be asked about [list main topics, or give sample questions]. The interview will be audiotaped [or videotaped], transcribed, and made available for public use at the [wherever it will be stored]. Any member of the general public will have access to this interview and published. The interview will take approximately [how long]. You may withdraw from the interview at any time. The originals and copies will be housed at [wherever they will be housed]. If you have questions about the research project or procedures, you can contact [ name] at XXXXXXXX phone number: XXX-XXXXXXX, or [email].
COMPLETE THIS FORM. I, ____________________________________________________________ [name of interviewee], knowingly and voluntarily permit these students, _____________________________ [name of student interviewer] of ______________________________ [name of class and high school] the full use of this information for educational purposes. This tape may become part of a classroom collection of oral hsitoy tapes, to be used this and in the future Signature____________________________________________________________ [interviewee] Printed Name_________________________________________________________[interviewee] Interview Location_________________________________________________________________ Interview Date____________________________________________________________________