Consent Form for Participation in a Focus Group

CONSENT FORM FOR PARTICIPATION IN A FOCUS GROUP

1. Information on the research project

You have been invited to participate in the following research project:

SPECIFY THE TITLE OF YOUR RESEARCH PROJECT HERE (REMEMBER TO REMOVE ALL INSTRUCTIONS IN GREY BEFORE SUBMITTING THE DOCUMENT TO THE REB.)

This project is being conducted by:

YOUR STATUS (EX. PROFESSOR, MASTER’S OR PH.D. STUDENT) YOUR NAME, YOUR EMAIL ADDRESS, YOUR TELEPHONE NUMBER

SUPERVISOR, CO-SUPERVISORS, CO-INVESTIGATORS, THEIR NAMES, EMAIL ADDRESSES, TELEPHONENOs.:

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Master’s OR Ph.D. student, HEC Montréal:

YOUR NAME

Tel.: 000-000-0000

Email:

Supervisor:

NAME

Tel.: 000-000-0000

Email:

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Summary: PROVIDE A BRIEF SUMMARY OF YOUR RESEARCH PROJECT, USING LANGUAGE THAT RESPONDENTS CAN EASILY UNDERSTAND (AVOID JARGON). MAXIMUM OF 5 LINES.

2. Research ethics considerations

Your participation in this research project is strictly voluntary. You have the right to refuse to answer any of the questions that may be put to you during the focus group. In addition, you may ask to end the interview at any time, in which case the researcher would be prohibited from using the information gathered. You may also ask for a transcript of your comments and request that the researcher refrain from using all or part of these comments.

HEC Montréal’s Research Ethics Board has determined that the data collection related to this project meets the ethics standards for research involving humans. If you have any questions related to ethics, please contact the REBsecretariat at (514) 340-7182 or by email at . Do not hesitate to ask the researcher any questions you might have.

3.Confidentiality of personal information gathered

You should feel free to answer the questions frankly. The researcher, as well as all other members of the research team, if applicable, undertake to protect the personal information obtained by ensuring the protection and security of the data gathered from participants, by keepingall recordings in a secure location, by discussing the confidential information obtained from participants only with the members of the research team and by refraining from using in any manner data or information that a participant has explicitly requested be excluded from the research.

Furthermore, the researchers undertake not to use the data gathered during this project for any purpose other than that intended, unless approved by HEC Montréal’s Research Ethics Board. Please note that by consenting to participate in this research project, you also consent that the data gathered may be used for future research projects, subject to approval of any such projects by HEC Montréal’s Research Ethics Board.

All persons who may have access to the content of your interview, as well as the person in charge of transcribing the interview, have signed a confidentiality agreement.

4. Protection of personal information in the publication of research results

The transcript of the interview will be kept confidential, but the researcher will use this information to produce an analysis and research documents (articles, presentations, reports, master’s or doctoral theses) for publication. IT IS NOT ESSENTIAL TO OFFER A CHOICE; A SINGLE OPTION MAY SUFFICE.It is up to you to indicate the level of protection of your personal information that you would like with regard to the publication of the research results.

KEEP ONLY THOSE OPTIONS THAT YOU PLAN TO ACTUALLY USE. FOR EXAMPLE, IF YOU DO NOT PLAN TO DISCLOSE NAMES IN YOUR RESULTS, YOU DO NOT NEED OPTION 1. MOREOVER, THE OPTIONS SHOULD REFLECT YOUR SPECIFIC SITUATION.

-Level of confidentiality

IF THERE IS NO CHOICE OF OPTIONS FOR THE LEVEL OF CONFIDENTIALITY (IN THIS CASE, REMOVE THE CHOICE OF OPTIONS):

I agree to participate in this research project.

INCLUDE THE STATEMENT BELOW (CHOOSE ONE ONLY) THAT APPLIES TO YOUR PROJECT:

If you check this box, no information concerning your name will be disclosed in the dissemination of the research results. However, since the discussion takes place in a group context, complete protection of your anonymity cannot be assured.

If you check this box, the researchers can quote your comments and mention your name in any documents or research articles produced following this study.You should not expect your anonymity to be protected in this case.

IF THERE IS A CHOICE OF OPTIONS FOR THE LEVEL OF CONFIDENTIALITY (IN THIS CASE, REMOVE THE PRECEDING PARAGRAPH):

Option 1:

I give my consent for my name to be disclosed in the dissemination of the research results.

If you check this box, the researchers can quote your comments and mention your name in any documents or research articles produced following this study. You should not expect your anonymity to be protected in this case.

Option 2:

I do not want my name to appear in the dissemination of the research results.

REMOVE THIS SECTION IF IT DOES NOT APPLY TO YOUR PROJECT:

-Consent for audio recording of the interview:

I give my consent for the researcher to make an audio recording of this interview.

I do not give my consent for the researcher to make an audio recording of this interview.

PARTICIPANT’SSIGNATURE:

First and last name: ______

Signature: ______Date (dd/mm/yyyy): ______

RESEARCHER’S SIGNATURE:

First and last name: INDICATE YOUR NAME______

Signature: ______Date (dd/mm/yyyy): ______

YOU MUST SIGN THIS DOCUMENT IN THE PRESENCE OF THE RESPONDENT AND GIVE HIM/HER A SIGNED COPY.

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