Vietnam Oral History Project

Informed Consent Statement

 

___________________________________________ (name of donor)

___________________________________________ (address)

___________________________________________ (city)

___________________________________________ (county )

___________________________________________ (state)

___________________________________________ (zip)

___________________________________________ (telephone number)

 

 

Prof. Philip F. Napoli of the Brooklyn College Department of History is recording the memories  that New Yorkers and others have about the Vietnam War and its long term significance.

 

If you chose to take part in this project, he (or one of his associates) will ask you a series of open-ended questions about your life and memories. The interview may be audio taped, video taped or both.  The interview will take approximately two hours.

 

There are no anticipated benefits to participation, and the risks associated with oral history are likewise not known to be significant.

 

However, you can withdraw from the interview at any time without prejudice prior to the execution and delivery of a deed of gift (see the attached form). You will also have the opportunity to make special provisions or restrictions in the deed of gift. During the interview you may request to stop the recording at any time to discuss or clarify how you wish to respond to a question or topic before proceeding. In the event that you choose to withdraw during the interview, any tape made of the interview will be either given to you or destroyed.

 

Subject to the provisions of the paragraph below, upon completion of the interview the tape and content of the interview belong Prof. Napoli, and the information in the interview can be used by Prof. Napoli in any manner he will determine, including, but not limited to, future use in presentations and publications.

Prof. Napoli agrees that:

  1. He will not use or exercise any of his rights to the information in the interview prior to the signing of the deed of gift.
  2. The deed of gift will be submitted to you for your signature before the interview or, if you choose, after the interview.
  3. Restrictions on the use of the interview can be placed in the deed of gift by you and will be accepted as amending Prof. Napoliís rights to the content of the interview.

 

Upon signing the deed of gift, the recordings will be kept in the possession of Prof. Napoli.

 

If you have questions about the research project or procedures, you may contact Prof. Napoli at 521 Whitehead Hall, 2900 Bedford Ave., Brooklyn, NY 11210 (718-951-5323) for an explanation at any time. 

 

If you feel you have not been treated according to the descriptions in this form, or that your rights as a participant in research have been violated during the course of this project, you may contact Professor David Balk, Chair, Committee on the Rights and Welfare of Human Subjects, Brooklyn College, CUNY, 2900 Bedford Ave., Brooklyn, NY 11210 (718) 951-5601.

Interviewer signature_____________________________________

Interviewee signature_____________________________________

Date __________________________________________________

Approved use of this form will expire August 15, 2007.