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The aim of this form is to facilitate informed consent by communicating with participants in language that they can understand. The material below is a sample – not a holy text to be reproduced verbatim. Adapt it to fit the circumstances of your own study. Some of the sample text below assumes a study involving qualitative interview data. If that’s not your methodology, adapt the text to the approach you are using.
I ___________________________________ agree to participate in [name]'s research study.
The purpose of the study has been explained to me and I understand it.
I am participating voluntarily.
I agree that a payment of ____ will be made to me on successful completion of the study.
I give permission for my interview with [name] to be tape-recorded/ such personal details as I have provided to be kept on record.
I understand that I can withdraw from the study, without repercussions, at any time whether before it starts or while I am participating.
I understand I can withdraw my permission to use the data within ___ weeks of the study, in which case the material I have provided will be deleted. / I understand that after I am paid for my participation that I cannot further change my mind about whether the data may be kept or not.
I understand that anonymity will be ensured in the write-up by disguising my identity.
I understand that disguised extacts from what I say may be quoted in the thesis and any subsequent publications if I give permission below:
(Please tick one box)
JK Ver 1 2009-02-23