City ______________________________________
State,County ______________________________
Date ______________________________________
US History Class Oral History Project Informed Consent
1. I agree to participate in an interview in connection with the Gavilan College California
History Class Oral History Project. I understand that I will be asked about my life and
experiences. Unless I consent to further use of the material, the work will only be used in
class and on the anti-plagiarism website Turnitin.com as part of an oral history research
assignment for the student’s grade.
2. The interview will be audio recorded. In the interview I will be identified by name,
subject to my consent. I will also be identified by name in any transcript (whether
verbatim or edited) or written report of such interview, subject to my consent.
3. I understand that the interview series will take a minimum of three hours, and that I
can withdraw from the project at any time, though such a withdrawal could have a
negative impact on the grade of the student involved. In the event that I withdraw from
the interview after recordings are made, any audio recording made of the interview will
be either given to me or destroyed, and no paper will be made available in any public
media based on what I have shared.
4. Subject to the provisions of paragraph five below, I understand that, upon completion
of the interview, IF I CONSENT at the end of the interview process by signing A DEED
OF GIFT, separate from this INFORMED CONSENT, the audio recording and paper
written by the student, its sole owner, could be shared by the student with the Gavilan
College Oral History Archive and/or with one or more local historical organizations, and
that subject to my consent, the information in paper or recording could be used by these
entities in any manner it will determine, including, but not limited to, use by researchers
in presentations and publications.
5. Gavilan College and the historical societies agree that: (i) they will not use or exercise
any of its rights to the information in the interview prior to or in the absence of my
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 all organizations’ rights to the
content of the interview. I understand that I have the right to review the audio recording
or transcript of, or report on, the interview before I sign the deed of gift.
6. Any restrictions as to use of portions of the interview indicated by me also will be
edited out of the student’s final report paper.
7. I understand that at the conclusion of this particular study and upon signing the deed of
gift, the audio recording, and one copy of the student paper, will be kept by the Gavilan
College Oral History Archive and/or local historical organization/s.
8. If I have questions about the research project or procedures, I know I can contact
instructor Leah Halper at the Gavilan College History Department, 5055 Santa Teresa
Blvd., Gilroy, CA 95020, phone (408) 848-4846, email lhalper@garlic.com
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 Leah Halper for discussion of the problem.
____ I agree to be identified by name in any report based on this interview.
____ I wish to remain anonymous in any report pertaining to this interview. I wish to
have the audio recording(s) containing my interview closed to use.
Interviewer signature_____________________________________
Interviewee signature_____________________________________
Address _____________________________________
_____________________________________
_____________________________________
Phone number _____________________________________
consent date __/__/__
Last updated: October 2015