Your Stories

Send Stories

Your consent

You can download an Easy Read version of the form here and send the completed forms along with your story to:

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Surviving through Story
RIX Centre
Knowledge Dock Building
University of East London
4 - 6 University Way
London E16 2RD

If you would like to email us your form please email it to:

rixadmin@uel.ac.uk

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Or you can complete the online form below

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Your consent

1. Can we share your piece?

On our website
On social media like Facebook
On TV or radio
In books and articles for people to read
In newspapers and magazines
In talks performances and exhibitions
In funding applications
2. If you sent a photo, is it OK to use it with your piece?
3. Would you be happy for us to contact you to talk more about the project?
4. How shall we write about you? (tick ONE of these)

Please show us that you understand ....

Other people will look at your piece
You can ask to have your piece removed at any time by contacting us (see details below)
You can ask for your name or photo to be removed at any time by contacting us (see below)
We may need to change things in your piece (e.g. take out names that would identify you or other people.)
We will keep this form safe and private. But if we think there is a need to keep you (or someone else) safe we will tell someone who can help you.
You will use my contact details if you need to get in touch with me about my piece

Your contact details

NB You can use a curser on a computer or your finger or a stylus on a touch screen to sign above

Signature of parent, carer or guardian for children under 16 (essential for children under 16)

NB You can use a curser on a computer or your finger or a stylus on a touch screen to sign above

If you needed support to complete this form, please tell us:

NB You can use a curser on a computer or your finger or a stylus on a touch screen to sign above

If this form was completed on your behalf (best interests decision) please tell us:

NB You can use a curser on a computer or your finger or a stylus on a touch screen to sign above

Thank you for completing the forms. You have now finished!!
We look forward to sharing your story.

You can contact us at

rixadmin@uel.ac.uk

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Or by post to

Surviving through Story
RIX Centre
Knowledge Dock Building
University of East London
4 - 6 University Way
London E16 2RD

Remember: We ask for your contact details in case we need to get in touch with you about your piece. We will keep your personal information safe and private.
But if we think there is a need to keep you (or someone else) safe, we will tell someone who can help you.


We will delete your contact details after 7 years.

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This project has been reviewed by, and received a favourable opinion from,
The Open University Human Re-search Ethics Committee, reference HREC/3606/Tilley