Informed Consent Form Example

This is an example type of informed consent form for projects not dealing with medical
research, children & young adults, people with learning difficulties, crime, internet research
and/or research within organisation/workplace.
I, the undersigned, confirm that (please tick box as appropriate!
". I ha#e read and understood the information about the project, as pro#ided in the
Information $heet dated %%%%%%%%%%%%%%%%.
&. I ha#e been gi#en the opportunity to ask 'uestions about the project and my
participation.
(. I #oluntarily agree to participate in the project.

). I understand I can withdraw at any time without gi#ing reasons and that I will not
be penalised for withdrawing nor will I be 'uestioned on why I ha#e withdrawn.
*. The procedures regarding confidentiality ha#e been clearly explained (e.g. use
of names, pseudonyms, anonymisation of data, etc. to me.
+. If applicable, separate terms of consent for inter#iews, audio, #ideo or other
forms of data collection ha#e been explained and pro#ided to me.
,. The use of the data in research, publications, sharing and archi#ing has been
explained to me.
-. I understand that other researchers will ha#e access to this data only if they
agree to preser#e the confidentiality of the data and if they agree to the terms I
ha#e specified in this form.

.. $elect only one of the following!
I would like my name used and understand what I ha#e said or written as
part of this study will be used in reports, publications and other research
outputs so that anything I ha#e contributed to this project can be
recognised.
I do not want my name used in this project.

"/. I, along with the 0esearcher, agree to sign and date this informed consent form.

Participant:
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1ame of 2articipant $ignature 3ate
Researcher:
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1ame of 0esearcher $ignature 3ate