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I am over 18 and eligible to participate in this interview (circle one): YES NO
I agree to be interviewed for this project (circle one): YES NO
I agree to be audiotaped during this interview (circle one): YES NO
(At any time during the interview, we can turn off the recording if you say “off the record”)
I agree to let the Researcher (Laine Goldman) use the interviews and research for this YES NO
dissertation and subsequent professional publication/presentation projects (circle one)
PARTICIPANT’S SIGNATURE DATE INVESTIGATOR’S SIGNATURE DATE
PARTICIPANT’S NAME PRINTED DATE INVESTIGATOR’S NAME PRINTED DATE
(PRIMARY RESEARCHER’S SIGNATURE ELAINE (LAINE) GOLDMAN DATE
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