[ND] Oral Histories Project Interview Informed Consent Form

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City ______________________________________
State, County _______________________________
Date ______________________________________

Tulsa Oklahomans for Human Rights

GLBT History Project
Informed Consent

1. I hereby agree to participate in an interview in connection with the oral history project known as _____________________________________. I understand that I will be asked about _____________________________________________________________ _______________________________________________________________________.
2. The interview will be videotaped and/or audio-taped. In the interview I may be identified by name, subject to my consent. I may also be identified by name in any transcript (whether verbatim or edited) of such interview, subject to my consent. If I choose to remain anonymous, I know that the tape(s) of my interview will be closed to use, and my name will not appear in the transcript or reference to any material contained in the interview. I know that in the case of choosing to remain anonymous, my interview will only be identified by an internal GLBT History Project tracking number.
3. I understand that the interview will take approximately _____ hours and that I can withdraw from the project without prejudice prior to the execution and delivery of a deed of gift, a form of which is attached hereto. In the event that I withdraw from the interview, any tape made of the interview will be either given to me or destroyed, and no transcript will be made of the interview. I understand that a photograph of me will be taken or borrowed for duplication, and that if I withdraw from the project, the photograph will be given to me.
4. Subject to the provisions of paragraph five below, I understand that, upon completion of the interview, the tape and content of the interview belong to Tulsa Oklahomans for Human Rights, and that the information in the interview can be used by Tulsa Oklahomans for Human Rights in any manner it will determine, subject only to the limitations listed below.
5. Tulsa Oklahomans for Human Rights 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 me for my signature at 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 Tulsa Oklahomans for Human Right's rights to the content of the interview. I understand that I have the right to review the tape or transcript of the interview before I sign the deed of gift.
6. Any restrictions as to use of portions of the interview indicated by me will be edited out of the final copy of the transcript.
7. I understand that at the conclusion of this project and upon signing the deed of gift, the tape, photograph, and one copy of the transcript will be kept in the possession of Tulsa Oklahomans for Human Rights and its Archive.
8. If I have questions about the research project or procedures, I know I can contact _________________________________ at the GLBT History Project, TOHR, P.O. Box 2687, Tulsa, OK 74101, (918) 743-4297 or via e-mail at history@tohr.org.

If I feel I have not been treated according to the descriptions in this form, or that my rights as a participant in research have been violated during the course of this project, I know I can contact the President of the Board of Directors of Tulsa Oklahomans for Human Rights, P.O. Box 2687, Tulsa, OK 74101, (918) 743-4297 or by e-mail at bortolani@tohr.org.

____ 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 tape(s) containing my interview closed to use. I wish to have my transcript only identified by an internal GLBT History Project  tracking number.

____ I wish to have the following limitations placed on the use of my interview:

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Interviewer signature_____________________________________

Interviewee signature_____________________________________

Address _____________________________________

  _____________________________________

  _____________________________________

Phone number _____________________________________

Consent Date __/__/__