Gathering Consent Form

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THE GATHERING: COLLECTED ORAL HISTORIES OF THE IRISH IN
MONTANA
SUBJECT INFORMATION AND INFORMED CONSENT
Title: THE GATHERING: COLLECTED ORAL HISTORIES OF THE IRISH IN
MONTANA
Co-Sponsors:
The Irish Government Dept. of Foreign Affairs Emigrant
Support Program and The University of Montana
Project Director(s):
Bob O’Boyle
Irish Studies, Liberal Arts Building Room 117, University of Montana, Missoula, MT
59801
Special instructions:
If any details in this consent form are unclear to you, please ask the person who
gave you this form to them to you.
Purpose:
You are being asked to take part in a research study into the Oral histories of the
Irish and Irish Americans of Montana. You have been chosen
because of your cultural background, and participation is
voluntary. The purpose of this research study is to record and
archive the histories and traditions of the Irish and Irish Americans
of Montana.
Procedures: If you agree to take part in this research study, you will take part in a
recorded interview. You will be asked questions about your cultural background. Your
permission will be asked to include your interview in our archive, and possible
exhibition, publication, and other outcomes. You may also be asked to supply
photographs, copies of family papers and/or agree to be photographed/videoed [see
below*]. Photographs and video will be taken, with your permission, for possible use in
later exhibitions and or/a documentary/publication arising from this research. Consent
section is included at the end of this form.
This interview will take play at your local archive office/library/home/venue of your
choosing. The interview will approximately 60 minutes.
Risks/Discomforts:
Answering the questions may cause you to think about feelings that make you sad or
upset. There are not other anticipated discomforts for those contributing to this study, so
risk to participants is minimal. Your participation is voluntary and you may skip a
question or stop/withdraw at any time.
Benefits:
Although you may not benefit directly from taking part in this study, your contribution
will be archived and become part of the greater history of the Irish of Montana. You and
your family will have access to this archived material. You will be informed of any
exhibition, publications, and other possible outcomes, within the period of the study.
Confidentiality:
Your initials _________ indicate your permission to be identified by name in any
publications or presentations.
Compensation for Injury:
Although we do not foresee any risk in taking part in this study, the
following liability statement is required in all University of Montana
consent forms.
In the event that you are injured as a result
of this research you should individually seek
appropriate medical treatment. If the injury
is caused by the negligence of the University
or any of its employees, you may be entitled
to reimbursement or compensation pursuant
to the Comprehensive State Insurance Plan
established by the Department of
Administration under the authority of
M.C.A., Title 2, Chapter 9. In the event of a
claim for such injury, further information
may be obtained from the University’s
Claims representative or University Legal
Counsel. (Reviewed by University Legal Counsel, July 6,
1993)
Voluntary Participation/Withdrawal:
Your decision to take part in this research study is entirely voluntary.
You may refuse to take part in or you may withdraw from the study at any time.
Questions:
If you have any questions about the research now or during the
study contact:
Bob O’Boyle, The Gathering Director,
Email: bob@mtirishgathering.org
Telephone: 406-244-5865 or (406)531-3045
If you have any questions regarding your rights as a research
subject, you may contact the Chair of the IRB through The
University of Montana Research Office at 243-6670.
Statement of Consent:
I have read the above description of this research study. I have been informed of
the risks and benefits involved, and all my questions have been
answered to my satisfaction. Furthermore, I have been assured that
any future questions I may have will also be answered by a
member of the research team. I voluntarily agree to take part in
this study. I understand I will receive a copy of this consent form.
Printed (Typed) Name of Subject
Subject's Signature
________________________
Date
*Statement of Consent to be Audiotaped:
I understand that audio recordings will be taken during the study.
I consent to being audio recorded.
I consent to use of my audio recordings in presentations related to this study.
Subject's Signature
________________________
Date
Statement of Consent to be Videotaped:
I understand that video recordings may be taken during the study.
I consent to being video recorded.
I consent to use of my video recordings in presentations related to this study.
Subject's Signature
________________________
Date
Statement of Consent to be Photographed:
I understand that photographs may be taken during the study.
I consent to having my photograph taken
I consent to use of my photograph in presentations related to this study.
Subject's Signature
________________________
Date
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