Sample Consent Forms Individual Interviews Of Persons With Intellectual Disabilities (Page 2 of 2) in pdf

Sample Consent Forms Individual Interviews Of Persons With Intellectual Disabilities Page 2

7. I understand that if I share information about abuse that is happening to me or to someone

else, the interviewer may need to report this abuse to ______________________.

I have read and I understand this information. I agree to participate in this interview. If I

think of anything else I would like to add after the interview, I am free to contact

______________________ (agency) staff.

________________________________________________________________________

Signature/Date

_____________________________________

Print Name

________________________________________________________________________

Witness Signature

Note to staff: If the person indicated consent verbally, please note that here:

_________________________________________________________________________

Sample Consent Forms Individual Interviews Of Persons With Intellectual Disabilities Page 2