Upper Midwest Digital Folklore Archives 
Accession Form (Version 2:  12/1/11)  

Title of Project:	Dental Discourse  

Course: 	CA/FLR 522: Digitally Documenting	Everyday Communication	Instructor:  Robert Glenn Howard	 		
[e.g. Folklore 100: Introduction to Folklore]	

Year:	2011					Semester:     Fall
[e.g. 2008] 					[Fall, Spring, Summer]

Date(s) material was documented: 11-25-11, 12-9-11

Language(s): English

Places mentioned:  (town or county, state [spelled out], country)
Little Chute, Wisconsin, United States of America
Summary of Project: (100 words or less.) 

A look into the social dynamics of employees of a dental office concerning personal thoughts about their job, the office they work in, and memorable interactions around the office.

Restrictions, if any, placed on the use of this project by the Student or the Respondent: None

Keywords:   (terms that will help researchers find your fieldwork; include 3-5 terms)

 Folk Genre Keywords: (from the Ethnographic Thesaurus’ top term categories, e.g. Belief, Ritual, Music, Dance, Material Culture, Foodways, etc; list all that apply)			
Beings, Health, Social Dynamics, Space and Places, Work					
				
More Specific Subject Terms:  (from the Ethnographic Thesaurus, e.g. taverns, basket making, etc)
Social Groups, Teeth, Interpersonal Relations, Workplaces, Workers		
 				
Folk Group Keywords: (use list of ethnic terms handed out in class and/or the Ethnographic Thesaurus, e.g.  Family; Ethnic: Greek American, African American; Work: firefighters; Sports: baseball players; Gender; Sexualities; Others)
Dentistry Office Workers Colleagues 				
				
Cultural Practice, Motif, and Issue Keywords not described above: (examples: -making, Ho-Chunk pahkeh beadwork;  apples, bear, car, water, death, murder, changes in tradition, hybridity)
Dental Office, Anecdotes, Conversation 						

About the Student-Researcher:

Name of Student: Nic Meyer

Major/Dept:	Communications, Letters and Sciences		Year in College: (please circle one)
						Freshman	 Sophmore	Junior 		 Senior  
Gender:	Male		 Age: 	21				 Ethnicities (list specific ethnicities, not racial categories like “Asian”):	Caucasian	 Birthplace:	Appleton, Wisconsin	 	Significant places of residence, if different: (town or county, state [spelled out], country)    None				
Religious group affiliations:	Catholic			
				
List of Respondent(s):
 (Include the following information for EACH respondent from whom you have collect a consent form.  Copy and Paste a Respondent Information section for each respondent beyond those below.  Leave unused entries blank.  Number consecutively:  “No.4,” “No.5”.  These numbers should match your uploaded consent and release form document numbers (see below)).

Respondent Information 

Name of Respondent No. 1:  	Kelly Meyer		
						
Area of Expertise/Explanation of Focus: (what is it about this person that forms the basis for this project?)
Dental Hygienist 									
Relationship to student:	Mother									
									
Gender:	Female						
Age:   51	
Birthplace (town or county, state [spelled out], country):	Little Chute, Wisconsin		
 Significant places of residence , if different than above:	Appleton, Wisconsin		
		
If relevant, please provide the following:			
Ethnicities (list specific ethnicities, not racial categories like “Asian”):		
Religious background:				
Occupation:					
Hobbies:			
Other:		

Name of Respondent No. 2:  	Lucas Meyer		
						
Area of Expertise/Explanation of Focus: (what is it about this person that forms the basis for this project?)
Film Extra									
Relationship to student:	Brother									
									
Gender:	Male							
Age: 23	
Birthplace (town or county, state [spelled out], country):	Appleton, Wisconsin		
 Significant places of residence , if different than above:			
		
If relevant, please provide the following:			
Ethnicities (list specific ethnicities, not racial categories like “Asian”):		
Religious background:				
Occupation:					
Hobbies:			
Other:		

Name of Respondent No. 3:  		Dr. Michael Ebben D.D.S.	

Area of Expertise/Explanation of Focus: (what is it about this person that forms the basis for this project?)
Dentist
									
Relationship to student:	Acquaintance 									
									
Gender:	Male						
Age:	
Birthplace (town or county, state [spelled out], country):			
 Significant places of residence , if different than above:			
		
If relevant, please provide the following:			
Ethnicities (list specific ethnicities, not racial categories like “Asian”):		
Religious background:				
Occupation:					
Hobbies:			
Other:		

Name of Respondent No. 4:  		Carleen Biesterveld	

Area of Expertise/Explanation of Focus: (what is it about this person that forms the basis for this project?)
Dental Hygienist
									
Relationship to student:	Acquaintance 									
									
Gender:	Female						
Age:	
Birthplace (town or county, state [spelled out], country):			
 Significant places of residence , if different than above:			
		
If relevant, please provide the following:			
Ethnicities (list specific ethnicities, not racial categories like “Asian”):		
Religious background:				
Occupation:					
Hobbies:			
Other:	

Name of Respondent No. 5:  		Julie VanEperen	

Area of Expertise/Explanation of Focus: (what is it about this person that forms the basis for this project?)
Dental Hygienist
									
Relationship to student:	Acquaintance 									
									
Gender:	Female						
Age:	
Birthplace (town or county, state [spelled out], country):			
 Significant places of residence , if different than above:			
		
If relevant, please provide the following:			
Ethnicities (list specific ethnicities, not racial categories like “Asian”):		
Religious background:				
Occupation:					
Hobbies:			
Other:	

Name of Respondent No. 4:  		Dori Dercks	

Area of Expertise/Explanation of Focus: (what is it about this person that forms the basis for this project?)
Receptionist 
									
Relationship to student:	Acquaintance 									
									
Gender:	Female						
Age:	
Birthplace (town or county, state [spelled out], country):			
 Significant places of residence , if different than above:	Little Chute, Wisconsin		
		
If relevant, please provide the following:			
Ethnicities (list specific ethnicities, not racial categories like “Asian”):		
Religious background:				
Occupation:					
Hobbies:			
Other:	

List of Documents/Recordings:
 (Include the following information for EACH Document/Recording. List as much relevant information as possible.  Copy and Paste a Document Information section for each document beyond the five below.  Number consecutively:  “No.1,” “No.2”.  These numbers should match your uploaded document number.  This COMPLETED accession form should always be document 1.  You final cut of you video should be document 2.  All other interviews or other audio, photo, video, or text materials should be in separate files following.  There should be at least one audio file per interviewee.  Include relevant B-role etc.  Keep all files at 999 Megs in size or less.  Chunk longer video files in relevant documents of 999 Megs or less.)

No. 1	Accession Form

No. 2	Your Video Documentary Title:	Dental Discourse

No. 3	Name of Document: 1i1.mov

	Material Type:  (audio/video/photo/text and file format) Quicktime Video
Date Collected: 11-25-11
Places where material was collected: Little Chute, Wisconsin, USA
(town or county, state [spelled out], country)
	
Description: (include a summary of the document and any pertinent information, such as if it is a raw interview footage, B-Reel, and audio interview etc.)
Raw interview footage of a dental hygienist. Part 1 of 2.

	Social and/or Cultural Context: 

No. 4	Name of Document: 1i2.mov

	Material Type:  (audio/video/photo/text and file format) Quicktime Video
Date Collected: 11-25-11
Places where material was collected: Little Chute, Wisconsin, USA
(town or county, state [spelled out], country)
	
Description: (include a summary of the document and any pertinent information, such as if it is a final cut or raw footage)
Raw interview footage of a dental hygienist. Part 2 of 2.

	Social and/or Cultural Context: 

No. 5	Name of Document: 2i1.mov

	Material Type:  (audio/video/photo/text and file format) Quicktime Video
Date Collected: 12-9-11
Places where material was collected: Little Chute, Wisconsin, USA
(town or county, state [spelled out], country)
	
Description: (include a summary of the document and any pertinent information, such as if it is a final cut or raw footage)
Raw interview footage of a dental hygienist. Part 1 of 2.

	Social and/or Cultural Context: 

No. 6	Name of Document: 2i2.mov

	Material Type:  (audio/video/photo/text and file format) Quicktime Video
Date Collected: 12-9-11
Places where material was collected: Little Chute, Wisconsin, USA
(town or county, state [spelled out], country)
	
Description: (include a summary of the document and any pertinent information, such as if it is a final cut or raw footage)
Raw interview footage of a dental hygienist. Part 2 of 2.

	Social and/or Cultural Context: 

No. 7	Name of Document: 3i1.mov

	Material Type:  (audio/video/photo/text and file format) Quicktime Video
Date Collected: 12-9-11
Places where material was collected: Little Chute, Wisconsin, USA
(town or county, state [spelled out], country)
	
Description: (include a summary of the document and any pertinent information, such as if it is a final cut or raw footage)
Raw interview footage of a receptionist. Part 1 of 1.

	Social and/or Cultural Context: 

No. 8	Name of Document: 4i1.mov

	Material Type:  (audio/video/photo/text and file format) Quicktime Video
Date Collected: 12-9-11
Places where material was collected: Little Chute, Wisconsin, USA
(town or county, state [spelled out], country)
	
Description: (include a summary of the document and any pertinent information, such as if it is a final cut or raw footage)
Raw interview footage of a dentist. Part 1 of 2.

	Social and/or Cultural Context: 

No. 9	Name of Document: 4i2.mov

	Material Type:  (audio/video/photo/text and file format) Quicktime Video
Date Collected: 12-9-11
Places where material was collected: Little Chute, Wisconsin, USA
(town or county, state [spelled out], country)
	
Description: (include a summary of the document and any pertinent information, such as if it is a final cut or raw footage)
Raw interview footage of a dentist. Part 2 of 2.

	Social and/or Cultural Context: 

No. 10	Name of Document: 5i1.mov

	Material Type:  (audio/video/photo/text and file format) Quicktime Video
Date Collected: 12-9-11
Places where material was collected: Little Chute, Wisconsin, USA
(town or county, state [spelled out], country)
	
Description: (include a summary of the document and any pertinent information, such as if it is a final cut or raw footage)
Raw interview footage of a dental hygienist. Part 1 of 3.

	Social and/or Cultural Context: 

No. 11	Name of Document: 5i2.mov

	Material Type:  (audio/video/photo/text and file format) Quicktime Video
Date Collected: 12-9-11
Places where material was collected: Little Chute, Wisconsin, USA
(town or county, state [spelled out], country)
	
Description: (include a summary of the document and any pertinent information, such as if it is a final cut or raw footage)
Raw interview footage of a dental hygienist. Part 2 of 3.

	Social and/or Cultural Context: 

No. 12	Name of Document: 5i3.mov

	Material Type:  (audio/video/photo/text and file format) Quicktime Video
Date Collected: 12-9-11
Places where material was collected: Little Chute, Wisconsin, USA
(town or county, state [spelled out], country)
	
Description: (include a summary of the document and any pertinent information, such as if it is a final cut or raw footage)
Raw interview footage of a dental hygienist. Part 3 of 3.

	Social and/or Cultural Context: 

Consent and Release Forms
(Upload all consent and release forms that will be housed at “UW Archives.” Upload these AFTER all other documents are uploaded.  If there is a problem or you are in doubt, send all the .pdfs of the forms as an email attachment to the instructor and list the location of the forms as “with instructor.” Call them “Consent Form 1” and so on when you upload. If the respondents requested to be anonymous or had other restrictions, be sure to note that as you upload.)

Number of Consent Forms: 6

Number of Release Forms: 6

Number of Researcher Release Forums: 1