To be submitted by the person or persons being interviewed. Main Information Name * Mailing Address (All Contact Information for Internal Use Only) * Email * Phone * Class Section # * Name of Student Interviewer * Date of Interview * Date of Interview *: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Date of Interview *: Day Day12345678910111213141516171819202122232425262728293031 Date of Interview *: Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Consent Agreement * I do hereby give to California State University, Northridge the series of interviews recorded with me beginning on the date noted above for the benefit of the University Library and those faculty, students and other researchers served by the library for purposes consistent with the policies of the Trustees of the California State University. I give these as an unrestricted gift and I transfer to California State University, Northridge all right, title, and interest, including copyright. I place no restrictions on access to and use of the interviews. I understand that I may still use the information in the recordings myself without seeking permission from California State University, Northridge. Personal Health Information Agreement * PERSONAL HEALTH INFORMATION: I understand and agree that the submitted material may contain sensitive personal information about me, including personal health information, and that this information may be accessible to others. I agree not to include any personally identifiable health information about others. Leave this field blank