View source for RECOUP/Ethical issues/Example consent form/handout

<noinclude>{{RECOUP_header|Ethical_issues/Example_consent_form/handout}}</noinclude>
=== Example consent form for research projects in general ===
'''CONSENT FORM '''Project title: ''(Add name here)'' Material gathered during this research will be treated as confidential and securely stored. Please answer each statement concerning the collection and use of the research data. 


{| class="prettytable"
| I have read and understood the information sheet. 
| <div align="right">Yes</div>
| 
| <div align="right">No</div>
| 
| 

|-
| I have been given the opportunity to ask questions about the study. 
| <div align="right">Yes</div>
| 
| <div align="right">No</div>
| 
| 

|-
| I have had my questions answered satisfactorily.
| <div align="right">Yes</div>
| 
| <div align="right">No</div>
| 
| 

|-
| I understand that I can withdraw from the study at any time without having to give an explanation.
| <div align="right">Yes</div>
| 
| <div align="right">No</div>
| 
| 

|-
| I agree to the interview being audiotaped and to its contents being used for research purposes. 
| <div align="right">Yes</div>
| 
| <div align="right">No</div>
| 
| 

|-
| I agree to being identified in this interview and in any subsequent publications or use. 
| <div align="right">Yes</div>
| 
| <div align="right">No</div>
| 
| 

|-
| I do not agree to being identified in this interview and in any subsequent publications or use. Where used my name must be removed and my comments made unattributable. 
| <div align="right">Yes</div>
| 
| <div align="right">No</div>
| 
| 

|-
| I agree to the transcripts (in line with conditions outlined above) being archived and used by other bona fide researchers. 
| <div align="right">Yes</div>
| 
| <div align="right">No</div>
| 
| 

|-
| I agree to my audiotapes (in line with conditions outlined above) being archived and used by other bona fide researchers. 
| <div align="right">Yes</div>
| 
| <div align="right">No</div>
| 
| 

|-
| I would like to see a copy of my transcript. 
| <div align="right">Yes</div>
| 
| <div align="right">No</div>
| 
| 

|-
| I would like my name acknowledged in the report and on the project web site (without linking it to content or quotation)
| <div align="right">Yes</div>
| 
| <div align="right">No</div>
| 
| 

|}
Name (printed) ______________________________________________ Signature _______________________________ Date_______________ Feel free to contact us if you have any further questions. 

The name(s) of the main investigators, along with telephone and email contact details are: ''(Add names here)'' 


Source: [http://www.esds.ac.uk/aandp/create/consentgen.asp http://www.esds.ac.uk/aandp/create/consentgen.asp] (Economic and Social Data Service, Universities of Manchester and Essex)
<noinclude>{{RECOUP_footer|Ethical_issues/Example_consent_form/handout}}</noinclude><noinclude>[[Category:RECOUP]]</noinclude>