Consent Form

Christy Fernandes
En 101
Professor Bess Fox
9/21/10

Interview Consent Form Draft

I _ hereby agree to participate in an interview in connection with an oral history project known as Digital Stories. I understand that this interview is subject to interpretation by Christine Fernandes in professor Bess Fox En 101/Discover Course. I understand that this interview will be either audio taped or documented. In the interview I may be identified by my name unless I choose to be anonymous. I understand that I may withdraw from the project at any point in time. In the event that I withdraw any tape or document made will be given to me. I realize that once this interview is turned into a visual audio, it will be published online.

If I have any questions about the project I know that I may contact Christine Fernandes by email at ude.tnuomyram|sednanref_C#ude.tnuomyram|sednanref_C or by phone (571)294 4866, or that I may contact the professor Bess Fox at ude.tnuomyram|xofb#ude.tnuomyram|xofb.

Interviewer Signature _

Interviewee Signature _

Consent Date

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