OLD – consent form WRI oral history project

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NOTE:  This is a sample release form form another project, not the OWS Oral History consent form.

ORAL HISTORY INTERVIEWEE RELEASE / CONSENT FORM

In consideration of the recording and preservation of my oral history narrative, and in view of the historical value of this oral history interview by the Welfare Rights Initiative Digital Oral History Project, I the interviewee, __________________________________ knowingly and voluntarily permit Cynthia Tobar, the Project Manager/Principal Investigator of the Welfare Rights Digital Oral History Project, the rights to publish, quote from, broadcast in any medium, or otherwise use for non-profit purposes the recorded interview(s) recorded by the interviewer, the above-mentioned Project Manager/Principal Investigator, on the date of
__________________________, 2011. This includes the rights of publication in electronic form, such as placement on the Internet for access by that medium.

The interview will take between an hour to two hours to complete. At any time you can refuse to answer any questions or end this interview.

The risks from participating in this oral history project are no more than encountered in everyday life. The benefits of your participation is that it will add to the generalized knowledge of the Welfare Rights Initiative.

Likewise, I the above-mentioned Project Manager/Principal Investigator hereby agree to preserve the products of this oral history interview according to accepted professional standards of responsible custody and agree to provide the interviewee with access to the digitized interview(s) and transcript.

If you have any questions about this research, you can contact me at (212) 817-7072 or at ctobar[at]gc.cuny.edu.

Thank you for your participation in this project. I will give you a copy of this form to take with you.

__________________________  _________ ____________________________   ______

Participant’s signature                     Date Principal Investigator’s signature       Date

 

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