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 Participant
_____________
Date
___________________
Signature
__________________
Name of person taking
consent if different
from Researcher
_____________
Date
____________________
Signature
__________________
Researcher
_____________
Date
____________________
Signature
HSSREC/Consent/Information Template/2011-12 v 2.2.
HSSREC/Consent/Information Template/2011-12 v 2.2.
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:



6
7
8
9
10
11
12
13
14
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.
A description of any benefits to the participant and/ or others, financial or
otherwise.
An 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).
Any foreseeable risks, inconvenience or discomfort to the participant.
An indication of the level of confidentiality and anonymity that can realistically
be guaranteed and details on how records will be stored and destroyed.
An indication of the level of debriefing /feedback that the participant can
expect.
Where a participant is not confident in the English language a translation
should be provided.
If permission is sought for the data to be used for other purposes an
explanation of these purposes should be given here.
Compensation arrangements for participants who suffer harm or injury from
the research must be made clear.
Contact 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
http://www.corec.org.uk/applicants/help/guidance.htm#gcp
HSSREC/Consent/Information Template/2011-12 v 2.2.