Paperwork information for Doris Lewis

[Ashleigh Taylor]

Crossroads to Freedom Digital Archive Project - Participant Agreement

I, _Doris S. Lewis_______________________________________, understand
that Rhodes College, Memphis, Tennessee, has organized and is managing
and operating a project, known as the Crossroads to Freedom Digital
Archive Project, (CFDA), to collect and record audio and/or video oral
histories from persons involved in or having information about the
Civil Rights movement, especially in the Mid-South area, and to
collect, preserve, exhibit, and publish these and related materials,
including without limitation photographs and manuscripts. These will
be deposited in the collection of the Crossroads to Freedom Digital
Archive and may be published and used online and in other ways.
These materials will serve as a record of the participants’
experiences and may be used for scholarly, educational, and
promotional purposes.
In consideration of the agreement of Rhodes College/CFDA to do so, and
for other good and valuable consideration, the receipt and sufficiency
of which I hereby acknowledge, I agree to participate in this project
by contributing information, including interviews, and perhaps other
materials, documents and things. I understand that I will receive no
monetary payment or other compensation for participating in this
project or for the interview(s), information, materials or things I
provide to the project, or for their use, exhibition, and publication.
I understand that my interview(s) will be recorded and that the
contents of my interview(s) will be transcribed in writing. Following
the interview(s), I will receive audio or video recording(s) and
transcript(s) of the interview(s).
I understand that I will have an opportunity to review, correct, and
edit the transcript of the interviews. I agree to assist with this
review in a timely fashion and to make every effort to ensure the
accuracy of the information I contribute.
I hereby grant to Rhodes College/CFDA the non-exclusive rights to any
audio and video recordings and transcripts resulting from my
participation, as well as the non-exclusive rights to any other
property or things that are the product of my participation including
without limitation performance, photographs, and written materials.
I understand that Rhodes College/CFDA plans to retain the products of
my participation as part of the archive and that the materials will be
used for exhibition, publication, and publication on the World Wide
Web, any successor technologies, and other media, and for scholarly,
educational, and promotional purposes.
I grant to Rhodes College/CFDA my absolute and irrevocable consent for
the use, exhibition, and publication of any photograph(s), videos,
documents, or things provided by me or received from me in the course
of my participation to be used and published by Rhodes College/CFDA in
any medium.
I agree that Rhodes College/CFDA may use my name, video or
photographic image or likeness, statements, performance, and voice
reproduction, or other sound effects, and all other documents and
things received from me or resulting from my participation in the
project without further approval on my part.
I hereby release Rhodes College and CFDA, and their respective
Trustees, Officers, Directors, agents, and employees (the “Released
Parties”), from any and all claims and demands arising out of or in
connection with the use of such recordings, documents, artifacts, or
other things provided by me, including but not limited to, any claims
for defamation, invasion of privacy, or right of publicity, and agree
to indemnify and hold the Released Parties harmless from any claim by
any third party, including without limitation any claim based upon
alleged defamation, breach of privacy, or other cause of action.
I agree that Rhodes College and CFDA shall have the right to assign
their rights in and to the material created and/or compiled by and for
the CFDA. The terms of this release extend to, and have full legal
effect upon any and all said assignees or sub-assignees.
ACCEPTED AND AGREED
Signature _Doris S.
Lewis___________________________________________Date _June 23,
2010______________
Printed Name ___Doris S.
Lewis________________________________________________________

Address__1858 Edward Ave.
_______________________________________________________________

City _Memphis_________________________________ State _TN_____ ZIP
_38107_________________

Telephone (_901______) -____2787735________________ Email
_dsle...@peoplepc.com_________________________

Interviewer’s signature

_____________________________________________________Date
_____________


Printed
name_____________________________________________________________


______________________________________________________________________________________________________________________________________________________________

PRE-INTERVIEW QUESTIONNAIRE
This Questionnaire is used to prepare the interviewee for the
interview as well as the interviewer. This form needs to be completed
and returned at least 2 days prior to the interview. This form can be
emailed to Lauren Turner at tu...@rhodes.edu, faxed to Mrs. Cathy
Palmer at (901) 843-3553 , or mailed to College Relations, Attn:
Crossroads to Freedom, Rhodes College 2000 N. Parkway, Memphis, TN
38112-1690.


INTERVIEWER NAME _____________________________ DATE ______________


PART A: GENERAL INFORMATION

Name:
Lewis
Doris Jean
(Last)
(First) (Middle)

Maiden name (if applicable) _Smith_____________________

Occupation _Retired Educator______________________________ Date of
birth _______________


Have you ever been interviewed about your personal history before?

Date(s) of previous interview(s):
___No__________________________________________

Organization(s) or Individual(s) that conducted interview:


May this preliminary interview questionnaire and the summary to be
written based on it be used for research purposes?

_____Yes _____No


PART B: FAMILY BACKGROUND

Mother’s name: Rena Vietta Lee
Smith___________________________________________________

Place of birth:_Tipton County,
Tennessee______________________________________________________
(City/Town, State)

Date of birth: _August, 1893_______________________________ Deceased?
__Yes_________

Occupation: _Farmer, Homemaker_______________________________________

Father’s name: __Eddie Smith,
Sr._________________________________________________

Place of birth:_Tipton County,
TN______________________________________________________
(City/Town, State)

Date of birth: _March, 1894_______________________________ Deceased?
__Yes_______

Occupation: _Farmer, Lumber
Stacker_______________________________________

Names of siblings, if any: 1


Part C: CHILDHOOD

Place of Birth: __Memphis,
Tennessee________________________________________________________

Where did you grow up?
Memphis
TN Scutterfield/ north Manassas
St.,Manassas School
(City)
(State) (Neighborhood)



Where did you go to school?

Elementary _
MANASSAS__________________________________________________________

Junior
High__MANASSAS__________________________________________________________

High School
_MANASSAS__________________________________________________________

Post-Secondary Education: _UAPB, INDIANA UNIVERSITY, BLOOMINGTON
CAMPUS_____________________________________________

Part D: BACKGROUND

Do you consider yourself a member of any religion? If so, what
religion and denomination? (Optional)PROTESTANT


Did you serve in the military? If so, when and where did you serve?NO




Have you been a member of any political organizations or community
organizations?

AARP, NAACP, MANASSAS ALUMNI, UAPB ALUMNI, INDIANA UNIV., ALPHA KAPPA
ALPHA SORORITY, INC. BEQ CHAPTER, MEMBER OF TRINITY CHRISTIAN
METHODIST EPISCOPAL CHURCH