I hereby certify that a tape-recorded interview with me was conducted on _______________ by _________________________ for the purposes of writing a class report for the Processes of Research & Engagement course (CCT692) in the Graduate College of Education at the University of Massachusetts, Boston in the xx semester, xx.

The following conditions (indicated by initials) shall govern the use of the tape(s).

____ a. No restrictions

____ b. If a transcript of the tape is made, I wish to read the transcript and make corrections and emendations.

____ c. My permission is required to quote or reproduce from the tape or corrected transcript (if applicable).

____ d. Only if the class paper is subsequently to be submitted for publication or used in the preparation of any manuscript intended for publication do I need to be consulted, in which case a new release form governing the use of the material must be provided and signed by me.

____ e. Only if other scholars want access to the tape or corrected transcript (if applicable) do I need to be consulted, in which case a new release form governing the use of the material must be provided and signed by me.

This constitutes our entire and complete understanding.

Name

Signature

Date