Participant identification number where applicable

CONSENT FORM

Project Title:
Name of Researcher:
(to be completed by participant)
I confirm that I have read and understood the information sheet dated / DATE:
On Information Sheet

For the above project which I may keep for my records and have had the opportunity to ask any questions I may have.

I agree to take part in the above study and am willing to:

List any procedures that are to occur

Eg – be interviewed, to have my interview videotaped

I understand that my information will be held and processed for the following purposes:

List any purposes for which data will be used including future use and any organisations/persons (generic if necessary) who may need access to the information.

I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason without being penalised or disadvantaged in any way.

______

Name of ParticipantDateSignature

______

Name of person takingDateSignature

consent if different

from Researcher

______

ResearcherDateSignature

Guidance on Information Sheets

The information sheet for participants must be included with your application to the Humanities and Social Sciences Research Ethics Sub-Committee and the below information should be used as guidance to be tailored to your projects needs.

An Information sheet must provide all the information necessary for prospective participants to make informed decisions about whether they wish to participate in research. Your information sheet must be written in a language that potential participants could reasonably be expected to understand and must be factual and free from coercive language or unjustified claims.

The following criteria should be addressed in any information sheet:

  1. The University of Warwick must be identified as the responsible institution (Information sheet should be on University Letterhead)
  2. The information must be communicated clearly, avoiding acronyms or jargons wherever possible, including an explanation if used.
  3. The name of the Principal/Lead Investigator and title of the research must be included.
  4. It must be made clear that this is a study which the participant is being asked to volunteer for and that their participation is entirely voluntary and they may withdraw at any time with an assurance that this will not affect future treatment (where applicable) or have any negative consequences.
  5. An explanation in clear, lay language:
  • of the nature and aims of the project,
  • of any inclusion/exclusion criteria
  • (where relevant) of how the researcher will contact/has contacted the participants.

6A description of any benefits to the participant and/ or others, financial or otherwise.

7An outline of what will happen to the participant and how long they are likely to be involved in the project (their time and effort commitment).

8Any foreseeable risks, inconvenience or discomfort to the participant.

9An indication of the level of confidentiality and anonymity that can realistically be guaranteed and details on how records will be stored and destroyed.

10An indication of the level of debriefing /feedback that the participant can expect.

11Where a participant is not confident in the English language a translation should be provided.

12If permission is sought for the data to be used for other purposes an explanation of these purposes should be given here.

13Compensation arrangements for participants who suffer harm or injury from the research must be made clear.

14Contact details of someone who can answer queries about the research must be given and participants should be made aware of any arrangements for complaint.

For further guidance and examples of phrases that could be used please see COREC’s guidance on Information sheets and consent forms

HSSREC/Consent/Information Template/2011-12 v 2.2.