Respondent Consent Form

Attachment F:

RESPONDENT CONSENT FORM

Acknowledgment of Voluntary Participation

And Audio Recording

This interview is being conducted by The Urban Institute. The interview should last approximately one hour.

I have volunteered to be interviewed to discuss my experiences as part of the Museum Public Finance study.

• I understand that participating is completely voluntary. I can choose not to answer any question.

• I give permission for the researchers to audio tape the interview, and to the researchers working on the project to listen to it at a later time. I understand that the researchers on this study will keep all of the information completely confidential.

• I understand that the information that I provide will never be linked with my name and that it will remain confidential.

• I understand that participating in this interview will have no effect on future applications for support from IMLS or other Federal agencies.

If I have any questions about this study, I may contact Carlos A. Manjarrez at the toll free number 1-XXX-XXX-XXXX.

Signature Date

_____________________________________

Respondent Name (please print)