Written Release Form

Person Interviewed (print)__________________________________________________



Phone (____)___________________ Email____________________________________

Place of Interview______________________________ Interview Date______________

Interviewer (print)_________________________________________________________

Interviewer's School _______________________________________________________

I understand that this interview and any photographs, tape recording, or video recording are part of scholarly research by students at the school named above. I give permission for the following (check all that apply):

______May be included in an educational publication, film, exhibit, or web site

______May include my name

______May be used but DO NOT include my name


Signature of Interviewee and Date


Signature of Parent or Guardian Interviewee is a Minor and Date

Oral Release Form

An alternative is to record this statement at the beginning of an interview.

This is __________________________(Interviewer) of __________________(School) on

______________ (Date). I am interviewing, photographing, tape and/or video recording

_______________________________ (Interviewee).

Do you understand that portions of this interview may be quoted or used in a publication, film, exhibit, or web site for nonprofit educational purposes? (Interviewee responds)