Please use a form like the one below when you ask your informant-consultant (the person you want to learn from and interview) to work with you. The “I” refers to your informant. Remove the name “Margaret ‘Peggy’ Yocom” and phone number and put your name and phone number in that place.

To contribute your and your informant’s paper to the Northern Virginia Folklife Archive, you will need to fill out two additional forms with your informant(s): the “Archive and Web Release Form” and the “Accession Form.”

Fieldwork Permission Form

I give Margaret (“Peggy”) Yocom (703-xxx-xxxx) permission to quote from our interview(s) and follow-up conversations about our interview(s) in her writings. I give her permission to use the photographs she has taken. I understand that I may ask to see drafts of what she has written using my words before she gives her paper to her teacher and/or publishes the material. I understand that if I want a copy of what she has written, she will give me one. (If the paper is a long one, I understand that I may need to help with the cost of it).

Signature: ______________________________________________________________

Please print name: ____________________________________________________

Would you like Peggy to use a different form of your name (first name only, for example) or a pseudonym? ____________________

Form of name or pseudonym you’d like Peggy to use _____________________________________

Date: ________________________________________

Address ______________________________________________________________

Telephone _______________________________

E-mail address(es) ______________________________________________________

Additional restrictions, comments, requests (Examples: I don’t want Peggy to use a certain section of our interview / I want to see a draft copy of her work / I want to receive or purchase a copy of her work).