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Sample Interview Consent Form

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qcireee
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27 views1 page

Sample Interview Consent Form

Uploaded by

qcireee
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SAMPLE

Consent to Participate in a Research Study

I agree to participate in a research study entitled [insert title of study]. The purpose of this study
is [describe the study, e.g. find out how to increase and improve parental involvement at the high
school level with a focus on how culture plays a role in parental involvement]. I understand that I
will be expected to participate and respond to [briefly describe the participation, e.g. two surveys
regarding parental involvement as well as answer a few interview questions regarding the same
topic].

I further understand:
• There are few risks associated with my participation in this study which may include validity.
• I may not directly benefit from participating in this research study.
• All records will remain private and any markers indicating my identity will be removed in
any published report of this study.
• All records associated with this study will be stored securely by [insert researcher name],
who will have sole access to these records.
• I understand that the interview will be recorded [describe how interview will be recorded,
e.g. using notes and a voice memo]. This evidence will remain in the possession of [insert
researcher name] for a period of not more than one year, at which time it will be destroyed.

My participation in this study is strictly voluntary and I can decline consent to be in the study at
any time. Declining consent will not affect my current or future relationship with [insert
researcher name] or [insert university name]. I can contact [insert instructor or advisor name] at
[insert email address] or [insert phone number] before or after my participation with any
questions related to this study.

All research is reviewed by a committee that works to protect participant rights and welfare. If
participants have questions or concerns about their rights as a research subject, they may contact
the [insert university name] Institutional Review Board by email to [insert IRB email address].

Participant’s Agreement
I have read the information provided above. I have asked all the questions I have at this time. I
voluntarily agree to participate in this research study.

Name: _________________________________________________

Signature: _________________________________________________

Date: _________________

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