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Interview Consent Form

Southern New Hampshire University: College of Online and Continuing Education

33 South Commercial Street, Suite 203

Manchester, NH 03101

1-866-860-0449

I, (please print your name) _______________________________________________, give

Southern New Hampshire University the absolute right and permission to use my written or spoken material for educational purposes in the JUS 261 online course. I understand that the written material may be used in a course presentation, discussion forums, or other educational setting.

The results of the interview will be used in course assignments or discussion forums, but your name or identity will not be revealed.

I release the University, the filmmaker/photographer, their offices, employees, agents, and designees from liability for any violation of any personal or proprietary right I may have in connection with such use. I am 18 years of age or older.

Name: ____________________________________________ Date: ____________________

Address: ___________________________________________State: ______ Zip: __________

Phone: ________________________ E-mail: _______________________________________

Signature: ____________________________________________________________________

Please return this form to the student(s) involved in the JUS 261 course, and you may keep one copy for your records. Should you have any questions please do not hesitate to contact the JUS 261 instructor or the SNHU College of Online and Continuing Education Office at 1-866-860-0449.