Tuesday, March 13, 2018

Consent form for RESEARCH INTERVIEW


(Title) Consent Form

You are being asked to take part in a research study of        .  I am asking you to take part because   .  Please read this form carefully and ask any questions you may have before agreeing to take part in the study.

What the study is about:
The purpose of this study is to

What I will ask you to do:
If you agree to be in this study, I will conduct an interview with you.  The interview will include questions about    .  The interview will take about   minutes to complete.  With your permission, I would like to tape the interview.

Risks and benefits:
There is the risk that you may find dome of the questions about    to be sensitive. 

The benefit is that


Your answers may be quoted in the project.  I will send you a copy of that portion before I finalize the project for your review.


Statement of Consent:
I have read the above information and consent to take part in the study.

Your signature:                                                                                                                                  

Date:                                                                                       

Your name (printed):                                                                                                                          


In addition to agreeing to participate, I also consent to having the interview recorded (audio only).

Your signature:                                                                                                                                  

Date:                                                                                       



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