TOLEDO STATE HOSPITAL



TOLEDO STATE HOSPITAL CEMETERY RECLAMATION PROJECT

RELEASE OF INFORMATION

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PRIVACY INFORMATION

The Toledo State Hospital Cemetery Reclamation Committee (TSHCRC) believes that acknowledging the lives, history and contributions of those buried in the Toledo State Hospital (TSH) cemeteries and those associated with the operation of TSH is an important part of restoring honor and dignity to those buried in the cemeteries. We also believe that increased public awareness of the TSH cemeteries and the history of psychiatric treatment will serve to fight the stigma against mental illness.

Information collected during this oral history project may be used in any or all of the following forums: historical data base, websites, historical publications, and community presentations, displays and events.

All identifying information provided to TSHCRC will be considered confidential unless permission is obtained to make it public. Please review the following privacy options. Your signature acts as authorization to TSHCRC to utilize information in a public forum. Sign only #1 for full authorization.

1. I authorize utilization of all information provided by me.

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OR

2. I authorize utilization with the following restrictions:

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THIS SECTION FOR OFFICE USE ONLY

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