Interview date: 01/01/2010
Location of interview: by telephone.
Jane A. Smith
100 Some Street
Middletown MI 00000
I, Jane A. Smith, the narrator, acknowledge that I have participated in an interview with Anna Cook, the interviewer, for the Oregon Extension Oral History Project and that the interview was recorded in digital audio form with my full and complete knowledge and consent.
I hereby give to Anna Cook the recordings of this interview and I grant and assign all rights, title, and interests, including copyright, of whatever kind, from this information and interview to Anna Cook with the understanding that all materials associated with this project will be licensed under the Creative Commons Attribution License which will allow others to reproduce and cite this interview free of charge as long as they give proper attribution.
I understand that my interview will by used, subject to any restrictions listed below, by Anna Cook as primary source material for her Master’s thesis on the Oregon Extension, which is being completed as part of her coursework in the Simmons College History/Archives Management program. I understand that such use may include, but is not limited to, publication in all media (print, graphic, film, and electronic media, including Web sites) currently in existence or yet to be developed in the future.
I understand that I will be given a chance to review and annotate any complete or partial transcripts made of the audio recording and that my comments will be added to the documentation associated with the audio interview.
I further understand that Anna Cook intends to donate the recorded interview and associated documentation to an archival repository for long-term preservation and use by scholars, researchers, educators, and the general public.
Any limitations I wish to place on the use of the audio recording, transcript, or associated documentation are enumerated below:
[space for limitations]
Signature of narrator and date
Signature of witness (interviewer) and date