Informed Consent Form printable pdf download

Study #______________

City____________________________

State, County____________________________

Date ____________________________

Indiana University Center for the Study of History and Memory

Informed Consent

Project Title Here

1. You are being asked to participate in an interview in connection with the oral history research project

known as _________________________. Your participation is voluntary. You will be asked about

____________________________________________________________________________________.

2. The interview will be audiotaped. In the interview you may be identified by name, subject to your

consent. You may also be identified by name in any transcript (whether verbatim or edited) of such

interview, subject to your consent. If you choose to remain anonymous, the recording(s) of your interview

will be closed to use, and your name will not appear in the transcript or in reference to any material

contained in the interview. If you choose to remain anonymous, your interview will only be identified by

an internal Center for the Study of History and Memory tracking number, which results in a minimal risk

of loss of confidentiality.

3. The interview will take approximately ____ hours and you can withdraw from the project without

prejudice prior to the execution and delivery of a deed of gift, a form of which is attached. In the event

that you withdraw from the interview, any recording made of the interview will be either given to you or

destroyed, and no transcript will be made of the interview. A photograph of you may be taken or borrowed

for duplication. If you withdraw from the project, the photograph will be given to you. You will receive

no payment for participation in this research, but you will receive a copy of the digital recording on CD

and a hard copy of the transcript for your records.

4. Subject to the provisions of paragraph five below, upon completion of the interview and signing of the

deed of gift, the digital recording and content of the interview belong to Indiana University, and can be

used by Indiana University in any manner it will determine, including, but not limited to, use by

researchers in presentations and publications. The deed of gift grants you an unrestricted license to use the

interview in any manner you choose.

5. Indiana University agrees that: (i) it will not use or exercise any of its rights to the information in the

interview prior to the signing of the deed of gift; (ii) the deed of gift will be submitted to you for your

signature at the completion of the interview; and (iii) restrictions on the use of the interview can be placed

in the deed of gift and will be accepted as amending Indiana University's rights to the content of the

interview. You have the right to review the digital recording or transcript of the interview before you sign

the deed of gift.

6. Any restrictions as to use of portions of the interview indicated by you will be edited out of the final

copy of the transcript.

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subject initials _______

Informed Consent Form