Del Rosario Form 2b Studs

HOLY CROSS OF DAVAO COLLEGE
Research Ethics Committee

Tel. No. (082) 221 – 9071 to 79 Local 136
Email: rec@hcdc.edu.ph
Sta. Ana Avenue corner C. De Guzman Street, Barangay 14-B, Davao City, Philippines
Other Campuses: Camudmud (IGaCOS) and Bajada (SOS Drive)
Informed Consent Form for Public Senior High School Students

Adapted from the WHO Informed Consent Template
(http://www.who.int/rpc/research_ethics/informed_consent/en/)
Name of Lead Researcher: Christine Mae Del Rosario

Title of the Study: Self-Consciousness and Community Engagement Among Public
Senior High School Students
Participant’s Name: _________________________________________________
SECTION I: INFORMATION SHEET
I. Introduction
A pleasant day to you. My name is Christine Mae Del Rosario, and I am currently taking
Master of Arts in Education Major in Teaching Social Studies at the Holy Cross of Davao College.
Currently, I am enrolled on Thesis Writing Subject as a requisite to finish my master’s degree.
With regards to my thesis writing subject, I would like to invite you to participate on a survey as
part of my research because you are fit to the inclusion criteria stipulated on my study.
Your participation is completely voluntary. Please read the information below and ask
questions about anything that you do not understand before deciding to participate. Please
take as much as time as you need to read the consent form. You may also decide to discuss it
with your family.
If you decide that you want to participate on this study, you will be asked to sign this
form. You may also copy this form for your keeping.
II. Purpose of the Research

I would just like you to know that once you partake in this study, you are helping me to
achieve the aim of this research which are to determine the level of self-consciousness and
community engagement of public senior high school students and is there significant
relationship between the two.
III. Type of Research Intervention

This research will involve your participation in not less than five minutes in answering
the research tool. There will be one research tool that will be utilized in the study. An adapted
Tel. Nos.: (082) 221-9071 to 79 • Telefax: (082) 221-3008 • Website: http://www.hcdc.edu.ph/ Accredited: PAASCU,
PACUCOA, ISO 9001:2008 • Member: APCAS, APSCUR, ATEIM, BEAM, CEAP, CHED, COCOPEA, COME, DACS,
DACUN, DCCII, FAAP, PAASCU, PACSB, PACUCOA, PAFTE, PAMI, PERAA, UMAP
Putting you ahead by providing affordable, quality, Catholic

education
Tel. No. (082) 221 – 9071 to 79 Local 136
survey question will be used and was reviewed by three (3) professional research validators in
the field of Social Studies to avoid misconceptions and to protect the participants from any
harm or prejudice. Furthermore, the research tool will be used to gather necessary information
based on the objective of the study.
IV. Participation Selection

Respondents are chosen randomly to engage in my study, because you have attributes
that match the inclusion requirements, you are hereby requested to participate.
V. Voluntary Participation
Your participation is entirely voluntary. Your refusal to participate will involve no penalty
or loss of benefits to which you are otherwise entitled. You may withdraw your consent at any
time and discontinue your participation without incurring any penalties. You are not waiving
any legal claims, rights, or remedies because of your participation on this research study.
VI. Procedures
A. This study employs the quantitative research methodology, which involves

quantitative data. Consequently, a survey questionnaire will be employed to collect data.
B. Since face-to-face data collection approach will be used in this study, a printed
questionnaire will be distributed, and the researcher will make sure to follow the guidelines of
the health and safety protocols imposed by the school and the government. You will be brief on
the subject matter of the study, and you can either complete the questionnaire yourself or have
it read to you. Just to emphasize, if a respondent wishes to withdraw from the survey at any
moment, he or she is free to do so. Respondents will be given adequate time to complete the
tool to collect valid data. All personal data acquired for this study will be treated with the
utmost discretion. Only the researcher will have access to your answer. After the study is
completed, responses will be archived and discarded. The questionnaires containing the
responses will be shredded and all data from other electronic devices will be erased.
VII. Duration
You will be given adequate time to complete the tool to collect valid data. Just to
emphasize, if you wish to withdraw from the survey at any moment, you are free to do so
VIII. Risks
There is no possibility that you will feel uneasy when answering the questions on the
research instrument. On the other hand, you may opt to not react to queries that make you feel

education
Tel. No. (082) 221 – 9071 to 79 Local 136
unable to respond or are unclear to you. Your participation is treasured by the researcher, and
your safety will be a top priority during the duration of the study. Additionally, the researcher
undertakes to adhere to the ethical standards outlined in this study.
IX. Benefits
Participating in this study will provide you with no immediate rewards. There will be no
impact on your real academic performance as a result of any of the information collected for
this study. However, in accordance with the goal of the study, you will have the chance to
participate in a study that will contribute to current academic knowledge and can be used for
the development of educational programs by the Department of Education. Furthermore, you
will be able to tie your current situations to the study's objectives. You may not receive any
direct compensation for your partaking in the study however, the researcher will make sure
that you will be properly recognize in the acknowledgement area of the paper. Your
contribution in this study is intended to aid the researcher in gaining a deeper understanding of
self-consciousness and community engagement among public senior high school students.
X. Confidentiality
The information acquired in this study will be kept private and treated with care.
Individual identities will not be utilized in any of the study's findings or publications. All
collected data, including summaries, will be coded, and stored separately from any
respondents' names or other direct identifiers. The information collected will only be used for
its intended purpose and will not be shared with any other parties. In compliance with the
current Republic Act 10173, commonly known as the Data Privacy Act of 2012, only the
researcher will have access to the collected responses of the respondents, which will contain
sensitive information. While the study is going on, the researcher will make sure to securely
store the data collected in a locked cabinet. Once the necessary information has been utilized
for this project, responses will be archived and discarded. The questionnaires containing the
responses will be shredded and all data from other electronic devices will be erased. In
addition, the researcher will ensure the informed consent of the respondents, keep their names
anonymous, and keep the information they supply confidential.
XI. Sharing the Results

The information acquired in this study will be disseminated more widely through various
platforms such as papers and conferences, but no personal information or information that can
be directly linked to a responder will be disclosed. The researcher also ensures that only
accurate data will be reported with full honesty in sharing information to ensure truthful
answers. If the respondents wanted to know the result of the study, it will be disclosed and be
made available to them. Then the result will be sent through electronic mail if asked. The

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Tel. No. (082) 221 – 9071 to 79 Local 136
researcher will make sure that the respondents confirmed the receipts of the email to
guarantee that they received the important result of the study.
XII. Right to Refuse or Withdraw

Your involvement on this study is fully voluntary. You do not have to partake in this
research if you do not wish to do so. You may change your mind later and stop participating
even if you agreed earlier. I assure you that if you choose not to participate, none of this will
affect your job anyway.
XIII. WHO TO CONTACT

If you have any questions, clarification, or any concerns about the study, please don’t
hesitate to contact me by calling on my mobile number: 09569132571.
SECTION II: CERTIFICATE OF CONSENT
I have been invited to participate in this study entitled “Self-Consciousness and

Community Engagement Among Public Senior High School students. This study focuses on the
level of self-consciousness and community engagement of public senior high school students
and the relationship between the two.
This section is mandatory.

I have read the foregoing information, or it has been read to me. I have had the opportunity
to ask questions about it and any questions I have been asked have been answered to my
satisfaction. I consent voluntarily to be a participant in this study.
Print Name of Participant: ______________________________________

Signature of Participant: ______________________________________
Date: [MM/DD/YYYY] ______________________________________
If Illiterate
A literate witness must sign (if possible, this person should be selected by the
participant and should have no connection to the research team). Participants who are illiterate
should include their thumb print as well.
I have witnessed the accurate reading of the consent form to the potential participant,
and the individual has had the opportunity to ask questions. I confirm that the individual has
given consent freely.

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Tel. No. (082) 221 – 9071 to 79 Local 136
Print Name of Witness: ____________________________ Thumb Print of Participant:

Signature of Witness: ____________________________
Date: [MM/DD/YYYY] ____________________________
STATEMENT BY THE RESEARCHER OR PERSON TAKING CONSENT
I have accurately read out the information sheet to the potential participant, and to
the best of my ability made sure that the participant understands that the following will be
done:
1. The participant will answer the questions pertaining to the subject of the research
only.
2. The participant voluntarily participates, he/she are not coerced, he/she can
withdraw anytime for any reason.
3.The participant’s identity and responses are kept with utmost confidentiality; the
data is accessible only to the researcher.
I confirm that the participant was given an opportunity to ask questions about the
study, and all the questions asked by the participant have been answered correctly and to the
best of my ability. I confirm that the individual has not been coerced into giving consent, and
the consent has been given freely and voluntarily.
A copy of this Informed Consent Form has been provided to the participant.
Print Name of Researcher or Person Taking the Consent: ______________________________

Signature of Researcher or Person Taking the Consent: ______________________________
Date: <MM/DD/YYYY>

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HOLY CROSS OF DAVAO COLLEGE

Research Ethics Committee

Informed Consent Form for Public Senior High School Students

Name of Lead Researcher: Christine Mae Del Rosario

Participant’s Name: _________________________________________________

SECTION I: INFORMATION SHEET

II. Purpose of the Research

III. Type of Research Intervention

Putting you ahead by providing affordable, quality, Catholic

IV. Participation Selection

A. This study employs the quantitative research methodology, which involves

Putting you ahead by providing affordable, quality, Catholic

XI. Sharing the Results

Putting you ahead by providing affordable, quality, Catholic

XII. Right to Refuse or Withdraw

XIII. WHO TO CONTACT

SECTION II: CERTIFICATE OF CONSENT

I have been invited to participate in this study entitled “Self-Consciousness and

This section is mandatory.

Print Name of Participant: ______________________________________

Putting you ahead by providing affordable, quality, Catholic

Print Name of Witness: ____________________________ Thumb Print of Participant:

STATEMENT BY THE RESEARCHER OR PERSON TAKING CONSENT

Print Name of Researcher or Person Taking the Consent: ______________________________

Putting you ahead by providing affordable, quality, Catholic

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