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(Sample) Informed Consent

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Please adjust the informed consent form here according to your study. Complete the sections in brackets
(<___>) with the necessary information regarding your study. REMOVE ANY UNNECESSARY
INFORMATION.
<Title of Study>
Description of the project
The aim of this study is to find out/examine/explore <detail what your study is about here>. To
participate in this study, you have to be an undergraduate student enrolled in the PSY106 Qualitative
Research module at HELP University, May 2019 semester.
What will be done
If you agree to participate in this study, you will be required to <participate in the interview/
understanding of the portion/ this interview will take 1 hour/ audio recording, you can stop at
anytime/ rest of group members will act as observer/explain steps involved in your qualitative study
here including any extra procedures; remember to mention audio recording>.
Risks or discomfort
<minimal risks> will be anticipated in this study as a result of <discussing of personal emotional
experience/ abortion/steps taken in this study>. However, you may decide to pull out anytime and you
will not face any consequences. If you experience any discomfort in participating in this study, you may
terminate your participation. If you’ve decided that you would not want to have your results included in
this study, you may inform the researcher and your results will be excluded.
CONTACTS
Benefits of this study
There will not be any direct benefit to you in participating in this study, but you will help the researcher to
learn more about <your specific area of research for this assignment>.
Confidentiality
Any information collected from you during your participation in this study will be anonymous. You will
not be identified as no names are required for participating in this research, and all identifying
information will be de-identified in the transcription process. The data collected will only be accessed by
the researchers and the supervisor of the researcher.
Decision to quit at any time
Participation in this study is on a voluntary basis. Even if you decided to participate in this study, you
may withdraw at any time. No adverse action will be taken against you for withdrawing your
participation. If you wish to terminate participation please inform the researcher immediately, so that your
responses can be separated and destroyed right at that point.
Rights and complains
This study has been reviewed and approved by the Ethics Review Board, Department of Psychology,
Faculty of Behavioral Sciences at HELP University. For any research related problems or questions
regarding participants’ rights, please contact the chairperson of the Ethics Review Board.
I understand that this research study has been reviewed and approved by the Ethics Review Board,
Department of Psychology, Faculty of Behavioral Science at HELP University. For research related
problems or questions regarding participants’ rights, I can contact:
Chairperson
Ethics Review Board
Department of Psychology
Faculty of Behavioral Science
Level 3, Block B
HELP University Subang 2
Persiaran Cakerawala
Seksyen U4
40150 Shah Alam
Selangor
Malaysia
Phone: 03-78493000
For any enquiries of this particular study, please feel free to contact the researcher via the email address
as stated below:
Researcher
<List your name and contact details here, including your email>
Researcher’s Supervisor
Karuna Thomas
karuna.s@help.edu.my
Thank you.
I have read and understand the explanation provided to me. I have had all my questions answered
to my satisfaction, and I voluntarily agree to participate in this study.
________________________
Signature of Participant
______________________
Date
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