STATEMENT OF INFORMED CONSENT
American Studies 2108
History 2108

Student Interviewer

Name   ________________

Address________________

_______________________

Phone_________________

Instructor
William W. Cutler
Professor of History
1115 W. Berks St., Room 913
Department of History
Gladfelter Hall
Temple University
215-204-7755

I.      Purpose of Interview

The purpose of this interview is to gather information for a term paper I am writing about the experience of growing up in the United States in the mid twentieth century.  I will be interviewing two different people, one who grew up in the 1940s and 1950s and the other who grew up in the 1960s and 1970s.  My study will help me understand how childhood and youth changed and how they remained the same during this critical time in American history.

Your interview is likely to take between one and two hours, depending upon what you remember and what you want to say.  It does not matter if you have perfect recall of events that took place more than fifty years ago.  I want to know what you do remember about your family, your friends, your neighborhood, your school, and anything else that was important to you when you were growing up.  If you think you may have difficulty speaking with me for more than one or two hours, please let me know now.  Interviews longer than one hour could be divided in two.

II.    Confidentiality
I will not reveal your name unless you give me written permission to do so.  The term paper that I write will be shared with my professor and other students in the class.  Portions of it will be posted on the class web site which is accessible only to the instructor and to the other students enrolled in the class.  At the end of the semester such postings will be stored in an private archive on the course web site.  Future students in the class may be given access to this archive.
III.   Risks/Inconveniences
I expect no physical or psychological risks from this study.  Should you need to stop or rest for any reason, please let me know and I will gladly accommodate you.
IV.   Benefits
By participating in this study, you will contribute to my understanding of American history in the twentieth and the understanding of my classmates.
V.     Right to Withdraw
You have a right to withdraw from my study at any time.  If you begin the interview but wish to stop for any reason, you may do so without any consequence for your future interactions with me or with Temple University.
VI.   Participant Rights
If you want to obtain additional information about this work, do not hesitate to ask me at any time before, during or after the interview.  You may also contact the instructor at the telephone number listed above.  If you want to obtain information about  the rights of participants in research conducted by Temple University, you may contact the Office of the Vice Provost for Research by dialing 215 707 3249.
By signing your name below, you are affirming that you have read and understand the purpose of this study and your rights as a participant.  Your signature means that you agree to be interviewed for my study.

_______________________________________________        Date_____________
Interviewee's Name (Please print)

____________________________________________________________________
Interviewee's Signature

____________________________________________________________________
Student's Signature

May I use your name in my paper?

Yes_______       No________

Please initial.