Participant Consent Form

The Qualitative Researcher | A Subthesis Resource

Disclaimer: This is a sample template only. You must adapt this form for your specific study and submit it to your Institutional Review Board (IRB) or ethics committee for approval before use with participants.

Study Information

Study Title:
Principal Investigator:
Institution:
Contact Information:
IRB Protocol #:

Purpose of the Study

You are being invited to participate in a research study. The purpose of this study is to:

What You Will Be Asked to Do

If you agree to participate, you will be asked to:

Expected duration of participation: _______________

Risks and Benefits

Potential Risks:

Potential Benefits:

Confidentiality

Your identity will be kept confidential. The following measures will be taken to protect your privacy:

Your name will be replaced with a pseudonym in all research records.
All data will be stored securely and accessible only to the research team.
Any identifying information will be removed or altered in publications and presentations.
Data will be retained for ___________ and then securely destroyed.

Voluntary Participation

Your participation in this study is entirely voluntary. You may:

Decline to participate without penalty.
Withdraw from the study at any time without consequence.
Refuse to answer any question during the interview or focus group.
Request that your data be removed from the study up until the point of data analysis.

Recording and Quotation Consent

Please indicate your preferences below:

☐ I consent to having this session audio recorded.

☐ I consent to having this session video recorded.

☐ I consent to the use of direct quotations from my responses in publications and presentations, attributed only by pseudonym.

☐ I do not consent to audio or video recording but agree to participate with written notes only.

Consent Signature

By signing below, I confirm that I have read and understood the information provided above. I have had the opportunity to ask questions, and my questions have been answered to my satisfaction. I voluntarily agree to participate in this study.

Participant

Printed Name:

Signature: Date: _______________

Researcher

Printed Name:

Signature: Date: _______________

A copy of this signed form will be provided to the participant.

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