(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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