RESEARCH CONSENT FORM
by Gary Shank
Date: Tue, 6 Feb 1996 12:08:00 CST
Sender: Qualitative Research for the Human Sciences
From: Gary Shank
Subject: Re: Human Subjects Review
To: Multiple recipients of list QUALRS-L
I have found that a good consent form, appended to my proposal,
does wonders for human subjects approval. I am attaching a
consent form that I use with my Intro Qual course here at NIU.
The students are required to hand in a signed copy with their
final reports. The form is designed to address most of the issues
raised in Review Board documentation.
gary
gshank@niu.edu
SAMPLE INFORMED CONSENT FORM
Researcher:
Name:
Address:
Phone:
Thank you for agreeing to participate in this study
which will take place from (date) to (date).
This form outlines the purposes of the study and
provides a description of your involvement and rights
as a participant.
The purposes of this project are:
1) to fulfill a course requirement for EPSY 525,
Qualitative Methods in Education, taught by Professor
Gary Shank at Northern Illinois University
2) to gain insight and experience in the topic of ____
The methods to be used to collect information for this
study are explained below. From this information, I
will write a case report about you.
(describe your methods briefly here)
You are encouraged to ask any questions at any time
about the nature of the study and the methods that I am
using. Your suggestions and concerns are important to
me; please contact me at any time at the address/phone
number listed above.
I will use the information from this study to write a
case report about you (the respondent). This report will
be read by you, the course instructor, and optionally, by
one other person if you give permission, in order to
check on the accuracy of the report. The case report
will not be available to any other person to be read
without your permission.
I guarantee that the following conditions will be met:
1) Your real name will not be used at any point of
information collection, or in the written case report;
instead, you and any other person and place names
involved in your case will be given pseudonyms that
will be used in all verbal and written records and
reports.
2) If you grant permission for audio taping, no audio
tapes will be used for any purpose other than to do this
study, and will not be played for any reason other than
to do this study. At your discretion, these tapes will
either be destroyed or returned to you.
3) Your participation in this research is voluntary; you
have the right to withdraw at any point of the study,
for any reason, and without any prejudice, and the
information collected and records and reports written
will be turned over to you.
4) You will receive a copy of the final report before it
is handed in, so that you have the opportunity to
suggest changes to the researcher, if necessary.
5) You will receive a copy of the report that is handed
in to the instructor.
Do you grant permission to be quoted directly?
Yes ______ No ______
Do you grant permission to be audiotaped?
Yes ______ No ______
I agree to the terms
Respondent ___________________________ Date _____________
I agree to the terms:
Researcher ___________________________ Date _____________
