Informed Consent Form (Page 2 of 2) in pdf

7. At the conclusion of this particular study and upon signing the deed of gift, the digital recording(s),

photograph, and one copy of the transcript will be deposited in the archive of the Center for the Study of

History and Memory and at the Indiana University Archive at Indiana University Bloomington. If you

indicate your permission on the deed of gift, a copy may also be provided to the organization that is the

focus of your oral history interview for educational and research purposes.

8. If you have questions about the research project or procedures, you can contact _______________ at

____________________________________________________________________________________

___________________________ or via e-mail at _____________________.

If you have questions about your rights as a research participant or wish to discuss problems, complaints or

concerns about the research study, or to obtain information, or offer input, contact the IU Human Subjects

Office at ________________________.

9. In consideration of all of the above, I give my consent to participate in this research study. I will be

given a copy of this informed consent to keep for my records.

____ I agree to be identified by name in any transcript or reference to any information contained in this

interview.

____ I wish to remain anonymous in any transcript or reference to any information contained in this

interview. I wish to have the digital recording(s) containing my interview closed to use. I wish to have my

transcript only identified by an internal Center for the Study of History and Memory tracking number.

Subject’s Signature: ________________________________________________Date:________________

(must be dated by the subject)

Subject’s Address _________________________________________

_______________________________________

Subject’s Phone number ______________________________________

Signature of Person Obtaining Consent _____________________________________________________

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subject initials _______

Informed Consent Form Page 2