Interview Quote Release Form
Grant permission to use your interview quotes for publication or other purposes.
Interviewee's Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization or Affiliation (if any)
Interview Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Interviewer's Name
*
Publication or Project Name
*
Please provide the quote(s) you are authorizing for release.
*
May we use your name alongside your quote(s)?
*
Yes, you may use my name.
No, please keep my quote(s) anonymous.
Signature
*
Submit Release
Submit Release
Should be Empty: