Volunteer Feedback Interview Recording Consent
Please complete this form to provide your consent for recording your feedback interview as a volunteer.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Method of Contact
Email
Phone
Text Message
Other
Date of Interview
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Interviewer Name
*
Type of Recording Consent Provided
*
Audio Recording
Video Recording
No Recording
Purpose(s) for which the recording may be used (select all that apply):
*
Internal training and quality improvement
Promotional materials (website, social media, etc.)
Reporting to sponsors or partners
Other
Do you wish to remain anonymous in any published material?
*
Yes, please keep my identity anonymous.
No, you may use my name and likeness.
Additional Comments or Restrictions (optional)
By signing below, I acknowledge that I have read and understood the information above and voluntarily consent to the recording of my feedback interview for the purposes indicated.
*
Submit Consent
Submit Consent
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