Sample Oral History Consent Form printable pdf download

Sample Oral History Consent Form

(Carefully edit for your individual project. Italics indicate portions that require editing,

but there may be other statements that do not apply, or need to be edited.)

[Name of project and/or organizations involved in this project]

Informed Consent Form

1. You are being asked to participate in an interview in connection with the ______________

Oral History Project. You are being asked to participate because [give reason or how selection

was made. E.g. you have lived in the area for more than 50 years].You will be asked about [list

main topics, or give sample questions, or otherwise indicate what types of issues may be

covered].

2. The interview will be audiotaped [or videotaped], transcribed, and made available for public

and scholarly use at [e.g. the Ellensburg Public Library and the Central Washington University

Library. If all recordings and transcripts will remain with the researcher rather than an

organization, give the individual’s name. ]. Any member of the general public will have access to

this interview and your words may be quoted in scholarly and popular publications.

3. The interview will take approximately [how long]. There are no anticipated risks to

participation in this interview. However, you can withdraw from the interview at any time

without prejudice prior to the execution and delivery of a deed of gift (see the attached form).

You will also have the opportunity to make special provisions or restrictions in the deed of gift.

During the interview you may request to stop the recording at any time to discuss or clarify how

you wish to respond to a question or topic before proceeding.

In the event that you choose to withdraw during the interview, any tape made of the interview

will be either given to you or destroyed, and no transcript will be made of the interview. [If the

project includes getting photographs, add: With your permission, a photograph of you will be

taken or borrowed for duplication. If you withdraw from the project, all copies of the photograph

will be given to you. Any negative or digital image will be destroyed.]

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

and content of the interview belong to [e.g. the Ellensburg Public Library or individual], and the

information in the interview can be used by [e.g. the Ellensburg Public Library or individual] in

any manner it will determine, including, but not limited to, future use by researchers in

presentations and publications.

5. The [organization or individual] agrees that:

A. 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.

B. The deed of gift will be submitted to you for your signature before the interview or, if

you choose, after the interview [or, after you review the tape and transcript].

C. Restrictions on the use of the interview can be placed in the deed of gift by you and will

be accepted as amending the [organization’s or individual’s] rights to the content of the

interview.

D. [Any other specific restrictions such as use of pseudonym; handling of personally

identifiable information that might be a threat to one’s employability, financial standing,

reputation, criminal or civil liability; etc.]

Sample Oral History Consent Form