CONSENT FORM
Purpose: I, __________________, a final-year student, am administering a psychological test as
part of my academic course. The purpose of this task is to gain practical experience in
psychological testing under the supervision of Madam Amena.
It involves a series of visits, each lasting up to maximum 1.5 hours and 6-7 times during the
whole semester. Your participation is entirely voluntary, and you have the right to withdraw at
any time without facing any penalties. Your decision is to participate or withdraw will not affect
your academic standing or relationship with the institution. Information will kept completely
confidential and your file when submitted to supervisor, anonymity will be maintained. You also
have the right to share only the information that you are comfortable with during this session.
Your level of disclosure is entirely at your discretion. You do acknowledge that, this interaction
will not result in dual relationships with me (the examiner) or you will not expect any favors or
benefits in return for your participation. If you would want, will give you verbal feedback.During
the sessions, if you have any questions or require assistance with the tasks, you have the option
to approach Madam Amena, the supervisor, for guidance and support.
I have carefully read and fully understand the terms and conditions outlined in this informed
consent form. I have had all my questions answered to my satisfaction, and I willingly agree to
abide by the rules and guidelines of this psychological testing.
Participant’s Signature: ---------------------------Date: ----------------------
Examiner Sign: ______________