INFORMED CONSENT AND DONATION FORM
Project title____________________________________________________
Collector______________________________________________________
(include name and phone of contact person, project director, or instructor)
To the participant:
Your special knowledge, skill or expertise represents a valued contribution to the
study of folklife at Western Kentucky University. In order to preserve your
knowledge for future students and researchers, the University asks that you give
your signed agreement to participate in this project and to permit use of the
materials that come out of this participation as part of the University's Kentucky
Folklife Archive.
The collector will explain to you in detail the purpose of the project, the
procedures to be used, and the potential benefits and drawbacks of participation.
You may ask the collector any questions you have to help you understand the
project.
Informed consent: I have read the summary of this project, and offer my
cooperation freely and voluntarily. I understand that refusal to participate in this
project will have no effect on any future services I may be entitled to from the
University. Anyone who agrees to participate in this project is free to withdraw
from it at any time. I understand that it is not possible to identify all possible
drawbacks or problems in a project, and I believe that reasonable efforts have
been made to minimize both known and potential but unknown risks.
Donation of materials: In consideration of the work Programs in Folk Studies and
the WKU Folklife Archive is doing to collect and preserve material of value for the
study of ways of life past and present in the upper South, I hereby donate the
following items:
1.
2.
3.
(additional items can be listed at the bottom of page 2)
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to be used by researchers as part of the Archives' collections. Scholars, faculty,
students, and others may use these materials for classroom demonstrations,
comparative studies, exhibitions, non-profit radio and television programs
produced at Western Kentucky University, and other projects deemed
appropriate by WKU’s Folk Studies program and the Folklife Archives. They may
also be commented on, quoted, or paraphrased in publications and in
dissertation and thesis research.
Stipulations:
___________________________________ __________________________
Signature of Participant
Date
___________________________________ _________________________
Signature of Collector
Date
Please use this form in conjunction with the Informant Data Form.
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