You must have this form filled out and signed by your interview subject. Copy this form and paste it into Word. Then print this form to take with you to the interview.


Interview Release Form


I give my consent for

_____________________________________________________ to use information from this interview in a written oral history which will be published on a class website. 


____________________________                              ____________

          (Signature)                                                                      (Date)


I give additional consent for the above named students to use photographs or excerpts from video tape on the website.


_______________________________                        ____________

          (Signature)                                                                      (Date)


Witnessed:  _____________________________________ (if required)