Ethical_issues/Example_consent_form/handout

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.

I have read and understood the information sheet.	Yes		No
I have been given the opportunity to ask questions about the study.	Yes		No
I have had my questions answered satisfactorily.	Yes		No
I understand that I can withdraw from the study at any time without having to give an explanation.	Yes		No
I agree to the interview being audiotaped and to its contents being used for research purposes.	Yes		No
I agree to being identified in this interview and in any subsequent publications or use.	Yes		No
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.	Yes		No
I agree to the transcripts (in line with conditions outlined above) being archived and used by other bona fide researchers.	Yes		No
I agree to my audiotapes (in line with conditions outlined above) being archived and used by other bona fide researchers.	Yes		No
I would like to see a copy of my transcript.	Yes		No
I would like my name acknowledged in the report and on the project web site (without linking it to content or quotation)	Yes		No

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 (Economic and Social Data Service, Universities of Manchester and Essex)

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Singal, N., and Jeffery, R. (2008). Qualitative Research Skills Workshop: A Facilitator's Reference Manual, http://oer.educ.cam.ac.uk/wiki/RECOUP, Cambridge: RECOUP (Research Consortium on Educational Outcomes and Poverty, http://recoup.educ.cam.ac.uk/). CC BY-NC-SA 4.0. (original page)