Interview Consent Form

By Brittany Jordan,2014-05-15 22:36
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(student's name) required coursework in the above-noted Athabasca University Women's Studies course. It is my understanding that this interview will cover

    Interview Consent Form

Course name and number:

    Assignment name and number:

I, __________________(participant’s name), understand that I am being asked to

    participate in an interview that forms part of _________________ (student’s name)

    required coursework in the above-noted Athabasca University Women’s Studies course.

    It is my understanding that this interview will cover the following subjects or topics: .





    I have been given some general information about this project and the types of questions I can expect to answer. I understand that the interview will be conducted at a place and time that is convenient to me, and that it will take approximately ______of my time.

    I understand that my participation in this project is completely voluntary and that I am free to decline to participate, without consequence, at any time prior to or at any point during the interview. I understand that, with my permission, this interview may be audio (or video) recorded and that any information I provide during the interview will be kept confidential, used only for the purposes of completing this assignment, and will not be used in any way that can identify me. All interview notes, tapes, or electronic records will be kept in a secured environment. The raw data will be offered to me no later than four months of the completion of the course assignment. If I decline it, it will be destroyed by the researcher. I will also be provided with a copy of the student assignment at my request.

    I understand that the results from this interview will be used exclusively in the below-named student’s Athabasca University course assignment and none of the information I provide will be published, in any form, in any journals or conference proceedings.

    I also understand that there are no risks involved in participating in this activity, beyond those risks experienced in everyday life.

    I have read the information above. By signing below and returning this form, I am consenting to participate in this project via telephone/ face-to-face interview/email exchange as designed by the below-named Athabasca University student.

Participant name (please print): _______________________________________

    Signature: _______________________________________________

    Date: _______________________________________________

Please keep a copy of this consent form for your records. If you have other questions

    concerning your participation in this project, please contact me at:

Student name:

    Telephone number: email address:

or my Athabasca University course instructor/tutor at:

    Course instructor/tutor name:

    Telephone number: email address:

or the Athabasca University Women’s Studies Course Coordinator at:

    Coordinator name:

    Telephone number: email address:

Thank you for agreeing to participate in my project.

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