Informed Consent Form

Interviewee Agreement

Literacy Biography Project

Appalachian State University, Boone, NC

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You have been asked to participate in the Literacy Biography Project, a class project at Appalachian State University. The student (who will sign this document) will ask you questions related to your reading and writing activities.

An audio- or video-recording of your interview may be made by the interviewer. A copy of this recording will be made available to you at your request. When finished, the student will write a biographical essay based on the interview. A copy of the essay will be provided to you on your request. The essay will be reviewed by an Appalachian State University professor, and may be used for other educational purposes. If you prefer to remain anonymous, a pseudonym will be used in the essay.

I, _____________________________________, hereby give my permission to be interviewed, and for a report to be written and submitted by the interviewer.

I DO DO NOT (please circle your choice) want to be identified by a pseudonym.

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Interviewee Signature Interviewer Signature

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Signature of parent or guardian

if interviewee is under 18

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Date