(name of interviewee)
_____________________________________, a student in ANTH/WS 220
(name of interviewer)
Life Histories/Self Narratives at Hollins University, to record my life story for the purposes of her class project. Furthermore, I agree to allow my life story to be posted on the course website.
I grant permission for my life story to also be used as part of the larger Hollins faculty/student collaborative research project entitled “Hollins Women Making Change” (Dr. LeeRay M. Costa, Principal Investigator) which may result in public presentations, and/or published work such as academic articles and books, and/or popular press articles about Hollins. Hence, I grant permission to Dr. LeeRay M. Costa to use my life story for these purposes. I understand that Dr. Costa will inform me of any published work that utilizes my name and life story.
I understand that any other use of my life story by outside parties not mentioned above (i.e., Hollins administrators and staff including admissions, graduate programs, marketing, external relations, etc…) requires additional and separate consent by me, the interviewee.
This contract indicates that I will be provided with a copy of my life story before it is posted to the website. I understand that I have the right to request the removal of any portion of the life story that I do not want to be posted to the website.
Likewise I, the above mentioned interviewer, and I, the Principal Investigator agree to respect the rights and privacy of the interviewee, and to provide the interviewee with a copy of her life story before it is posted to the website. I agree to respect the wishes of the interviewee about what portions of the life story will be posted on the website.
Signature of Interviewee _____________________________ Date ____________
Signature of Interviewer _____________________________ Date ____________
Signature of Principal Investigator _____________________ Date ____________
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In addition I grant permission for:
A) my real name to be used ____________________
B) my image to be used on the course website ____________________
C) a sound clip of my interview to be used on
the course website. ____________________
D) a written copy of my life story to be
deposited in the Special Collections of the
Wyndham Roberson Library ____________________
E) a digital audio copy of my life story to be
deposited in the Special Collections of the
Wyndham Robertson Library ____________________
NOTE: Please direct any questions or concerns to Dr. LeeRay M. Costa, the course professor and Principal Investigator, at 362-6254, lcosta@hollins.edu, Pleasants 324, Hollins University.