INTERVIEW CONSENT
My name is XXX. I am a graduate student in the XXX Program at the University of Illinois at
Springfield. I am conducting research as part of my master’s project and want to ask for your help. The purpose of this project is to look at XXX.
As part of my research I will be conducting interviews. I would like to interview you and ask permission to use your name and comments in my research. The interview will last approximately XXX. Since your name and comments will be used in the research, I cannot guarantee that your responses will be kept confidential. Your participation is completely voluntary. You have the right to withdraw from this research at any time without penalty. If you choose to participate, you do not need to answer any questions that make you feel uncomfortable or you do not want to answer. You may also withdraw your consent and participation at any time during the interview without consequence. {If using audio or video recordings, explain their use and that the recordings will be destroyed at the conclusion of the project. If transcripts are being made, discuss the security of the transcript and schedule for the destruction of the recordings. Also, discuss how the subject will be given the opportunity to review, change, or reject quotes before they are used in the research.}
If you have questions regarding the study or your participation, you can contact me at XXX or my adviser, Dr. XXX, at 217-206-xxxx.
The study has been reviewed by the UIS Human Subjects Review Officer. Dr. James Klein can answer questions about your rights as a volunteer participant in this project. He can be reached at 217-206-6883.
The results of my research will be available XXX (e.g. after July 1). Please contact me if you would like to see a copy of the results (or list where they will be available).
Consent Statement:
I have read the consent and understand my participation is completely voluntary. I know that I can stop my participation at any time with no negative consequences. By signing and dating this document I am consenting to participate in the research.
Signature
Printed name
Date
_______ I understand that the interview is being (audio, video, and/or transcribed) are being used with this research and by initialing here I am consenting to participate in this way.
_______ I understand that my name and comments will be used in the research and by initialing here I am consenting to participate in this way.
You will be given a copy of this form.