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Participant Consent Form for Doctoral Students1
Student Name2
Doctoral Student
SOAS, University of London
Title of Research Project:....2
Introduction
The purpose of this form is to provide you with information so you can decide whether to
participate in this study. Any questions you may have will be answered by the researcher or
by the other contact persons provided below. Once you are familiar with the information on
the form and have asked any questions you may have, you can decide whether or not to
participate. If you agree, please either sign this form or else provide verbal consent if you do
not wish your name to be registered on the form. Please also indicate whether or not you are
willing for your contribution to be audio recorded. Please note that this recording, a transcript
of it and any relevant notes may be placed in an online archive that is publicly available. You
have the right to withdraw your consent to this either entirely or unless any way of identifying
you has been removed from the data.
Please note your participation is voluntary and you may decide to leave the study at any
time. You may also refuse to answer specific questions you are uncomfortable with. You
may withdraw permission for your data to be used, at any time up to DATE2 in which case
notes, transcriptions and recordings will be destroyed. Withdrawal or refusal to participate
will not affect your relationship with3…..
Data Protection Statement
Information about you which is gathered in the course of this research project, once held in
the United Kingdom, will be protected by the UK Data Protection Act and will be subject to
SOAS's Data Protection Policy. You have the right to request access under the Data
Protection Act to the information which SOAS holds about you. Further information about
your rights under the Act and how SOAS handles personal data is available on the Data
Protection pages of the SOAS website (http://www.soas.ac.uk/infocomp/dpa/index.html), and
by contacting the Information Compliance Manager at the following address: Information
Compliance Manager, SOAS, Thornhaugh Street, Russell Square, London WC1H 0XG,
United Kingdom (e-mail to: dataprotection@soas.ac.uk).
Purpose of the Study
You have been asked to participate in a research study about [insert brief statement about
the research in non-technical language simple enough to be understood by
1
Please note it is your responsibility to ascertain any conditions of your grants, such as a requirement for
public data archiving.
2
Please note that all text highlighted in red needs to be replaced with the appropriate information.
3
Include this statement only if you have been introduced to this potential research subject by an organisation
with which he/she has a relationship (church/mosque, school/university, NGO, etc. And insert the name of this
organisation at the end of the sentence. But make it clear to those in the organisation that they must not
discriminate against this person for not wishing to participate.
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uneducated persons and full enough so they can understand what your research is
about]. The purpose of the research is [explain again in simplified language].
Use of the data
The findings will be used to form part of my thesis and will potentially additionally be
published in.....4
If you wish to receive a copy of the final thesis once completed I will happy to provide you
with an electronic copy.5
Procedures to be followed
To assist my research I am asking you to agree to participating in a [personal
interview/focus- group discussion/survey/....]6. We can arrange a time and date which is
convenient to you once you have confirmed your consent. The [interview/FGD/survey/..] will
take no longer than xxx to complete. [Please make it clear if this person will be asked to
participate more than once how many times and in what procedures and how long
each is likely to take]
Risks7
Compensation
You will not receive any type of payment for participating in this study.8
Possible benefits of the study9
Statement of Privacy and Confidentiality
In any publication based on the findings of this study, the data presented will contain no
identifying information that could associate it with you unless you specifically request to have
your real name associated with your responses.
Project Funders10
Security Measures11
Archiving12
4
Delete or complete the sentence.
If you have a substantive reason for not providing this then omit this sentence.
6
Clarify exactly what kind of procedure/s you want people to participate in.
7
Please complete this explaining realistically possible risks, including emotional/psychological ones and
explaining any steps you may be taking to minimise/ameliorate these.
8
If this is not the case please amend to reflect the situation.
9
If there are direct benefits that may reasonably be expected from this project then list them under the
statement: The possible benefits of participation are ...... If not then delete this heading.
10
Identify the funders of the project, and any interest which they may have in the research or control over use
of the research.
11
Describe in a general way any special security measures which will be put in place to protect research
participants’ data during the life of the project.
12
Describe how the data will be archived, e.g. in SOAS Research Online, and whether research participants will
be identifiable in the archived dataset.
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Contact Information
My telephone number is:13
My email address is:
Alternatively, you may wish to contact my supervisor, Professor/Dr. at (email/office phone).14
Confirmation and consent
I confirm that I have freely agreed to participate in the research project of STUDENT
NAME2. I have been briefed on what this involves and I agree to the use of the findings as
described above. I give/ do not give permission for the interview to be recorded.
I understand the recording, transcript and any notes may be archived and put on line for
public use. In this case I give my permission for this including data that might identify
me/provided all possible identification is removed.
Copyright Statement
By completing this form, you permit STUDENT NAME to edit, copy, disseminate, publish (by
whatever means) and archive your contribution to this research project in the manner and for
the purposes described above. You waive any copyright and other intellectual property
rights in your contribution to the project, and grant STUDENT NAME a non-exclusive, free,
irrevocable, worldwide license to use your contribution for the purposes of this project and
similar future research projects.
Participant signature:__________________________________________________
Name:________________________________________________________________
Date:_________________________________________________________________
I confirm that I agree to keep the undertakings in this contract.
Researcher signature:___________________________________________________
Name:__________________________________________________________________
Date:___________________________________________________________________
Please keep this form for future reference.
13
This should be both your UK mobile number and a local number in the country concerned if this is not the
UK. If you don’t yet have a SIM card from that country, state this here for now and explain for the ethics
committee you will include your number once you have one and before printing the consent forms. Then
delete your explanation when providing your in-country phone number.
14
If fieldwork is taking place outside the UK please add contact details for a local contact person supporting
your study who can be trusted by the research subject.
3
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f:\research\research integrity\final documents\7. sample participant consent form soas for
pgr students - funded by uk research councils.docx
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