This is an example of an interviewee release form. This form was used by Dr. Paul Sandul for
an oral history project concerning the local African American Heritage project. Important
points to note: who holds copyright, where materials will be held, listing of potential uses,
release of liability, and restrictions.
INTERVIEWEE RELEASE FORM:
I, _____________________________________, consent to the recording of my statements and do
hereby irrevocably grant to Stephen F. Austin State University (“University”) the right to copy,
reproduce, and use all or a portion of the recorded interviews (the “Interview”) conducted by
__________________________ on __________________. I understand that the Interview will be
deposited in the East Texas Research Center (ETRC) for the use of future scholars and may be used
for any lawful purpose in all forms and media including but not limited to public presentations, audio
or video documentaries, CD-ROMs, internet publications, slide-tape presentations, exhibits, and
advertising and related promotion through the world in perpetuity, and expressly permit such use.
This gift does not preclude any use that I myself may want to make of my words in these recordings
to the extent it does not conflict with this agreement.
I release University and its assigns, licensees and successors from any claims that may arise
regarding the use of the Interview including any claims of defamation, invasion of privacy, or
infringement of moral rights, rights of publicity, or copyright. I acknowledge that I have no
ownership rights in any work developed as a result of the Interview.
Restrictions: ______________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
I certify that I am over the age of eighteen (18), have read and fully understand the terms of this
agreement.
Signature of Interviewee & Date:_____________________________________________________
Address of Interviewee: _____________________________________________________________
_________________________________________________________________________________
Contact Information of Interviewee:____________________________________________________