Paper Help

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) ____________Michael Jefferson_________________________, give

Southern New Hampshire University the absolute right and permission to use my written or spoken material for educational purposes in the _PSU 632____:__Advance Developmental Psychology__________________. 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: _____Michael Jefferson ___________________________ Date: ____3/20/2016_______

Address: ___5523 NC Hwy 55 Apt 128________________State: __NC____ Zip: ___27713_____

Phone: ____919-251-8075___________ E-mail: [email protected]_____________

Signature: ___Michael Jefferson_____________________________________________

Please return this form to the student(s) involved in the __PSY 632___ course, and you may keep one copy for your records. Should you have any questions please do not hesitate to contact the __PSY 632___ instructor or the SNHU College of Online and Continuing Education Office at 1-866-860-0449.