Informed Consent Form/information Letter printable pdf download

Informed Consent Form/information Letter

TEMPLATE – INFORMED CONSENT FORM/INFORMATION LETTER

Include or exclude information as applicable.

Item #s are highlighted to reference the CREO guidelines. You should not include these

highlighted item numbers in your form/letter.

“INFORMED CONSENT FORM/INFORMATION LETTER”

1. Title of project

3. “You are invited to participate in a research study”. 3a. “The purpose of this study is …”

2. “This research project is being conducted by …” (describe the researcher(s) and their

affiliation).

INFORMATION

3d. Describe all procedures, preferably in chronological order, which will be employed in

the project.

3e. State the amount of time required of the participant per session and for the total

duration of the study.

If applicable to your study, describe:

3b. Description of the participants

3c. Selection of participants

12. The number of participants that will be participating in the research.

13. Information concerning taping or filming.

14. A disclaimer for the use of deception.

3f, 3g, 3h, & 15. RISKS

List the foreseeable risks or discomforts, if any, of each of the procedures to be used in the

study, and any measures which will be used to minimize the risks.

3i. BENEFITS

List the benefits you anticipate will be achieved from this research, either to the

participants, others, communities or the body of knowledge.

4. CONFIDENTIALITY

Describe how the confidentiality and anonymity of participants will be ensured. Describe

who has access to the data, where the data will be kept, and what will happen to the data

when the project is finished. Describe the extent, if any, to which confidentiality of records

identifying the participant will be maintained. OR, explain when and how confidentiality

will be broken. Provide a statement about the ways in which the research results will be

published or distributed. Participants must be told if quotations will be used in any write-

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Informed Consent Form/information Letter