Rogat+-+Individual+Interviews+Consent+Form

**__Informed Consent Form__** **(Student Researcher)** I understand that Michelle Rogat is an undergraduate student researcher who wishes to interview me as part of the requirement of the class titled Sustainability Research Design taught by Professor Kim Fortun of the Science and Technology Studies Department at Rensselaer Polytechnic Institute. The research conducted will contribute to a senior thesis to be completed in the Spring of 2014 in the class titled Senior Projects. Rogat’s senior thesis research will focus on the implementation of sustainability projects in businesses and the hospitality industry. I understand that she will be making her best possible effort to guarantee me every possible protection I require, including the following: 1. I am under no obligation to be interviewed if I do not wish to do so. 2. I am not obligated to answer any of the questions. I may decline to answer any or all of the questions, and I may terminate the interview at any point. 3. If there is anything that I do not wish to have quoted, I may say at any point during or after the interview say what I wish to have kept “off the record,” and it will not be quoted. I will only be audio recorded if I grant permission. 4. I understand that if Rogat decides to use any portions of this interview in subsequent publications that she will send me a copy of the portions of the interview, including any quotations and paraphrases that she decides to use, for my editing and written approval. I will have the right to edit the material and I will receive a copy of the final publication. Rogat will only use the material that I have approved. 5. I understand that I may choose to remain anonymous or have my name revealed. I may also change my mind at any point up to and including the review of any quotations and paraphrases that might be used (check one): _ I choose to remain anonymous. _ I choose to reveal my name. _ I choose to reveal my company, but leave my name private. 6. Based on reading this form (check one): _ I agree to be interviewed. _ I agree to be audio recorded. _ I do not agree to be interviewed.
 * Rensselaer Polytechnic Institute **

Name of Participant, Signature, Date

//Professor Kim Fortun, SAGE 5408 RPI, 110 8th Street, Troy, NY 12180// //(518)276-2199, fortuk@rpi.edu//
 * For further information contact:**

//Michelle Rogat, 28 Homestead Ave, Albany, NY, 12203// //(845)797-9036, michelle.rogat@gmail.com//

Chair, Institutional Review Board, Rensselaer Polytechnic Institute, CII 7015, 110 8th Street, Troy, New York, 12180; phone: (518) 276-4873, fax: (518) 276-4002.