PARTICIPANT AGREEMENT FORM

I understand that I am being interviewed and / or recorded for an ethnographic

research project conducted by ________________________ (name of student

researcher) for ________________________ (class) at ________________________

(university) taught by ________________________ (name of teacher). I agree to let

him / her use the interview to write a paper for the course listed above. This interview

will not be used for any other purpose. I have been informed that if I become

uncomfortable at any time during the interview, I do not have to answer questions or I can

ask to have the tape or video recorder (if used) turned off. I am aware that I can request

that a pseudonym be used. I also understand that by signing this form, I give permission for

the interview to be used for the purposes stated above.

Do you agree to participate in the interview? Yes no

Can the interview be recorded? Yes no

Should a pseudonym be used? Yes no

Date: __________________

Participant signature: ____________________________________________________