Appendix D: Informed Consent Form (Interviews)
Note: This version of the Free and Informed Consent Form will be adapted for the particular country where monitoring takes place.
I have read and understood the Information Sheet. The research procedures have been explained to me and all of my questions have been answered to my satisfaction. I have been informed that I can withdraw from the study at any time without penalty and that, if I choose to do so, any data collected as a result of my participation will be destroyed. The potential discomforts that I might experience because I have participated in the study have been explained to me. I also understand the potential benefits of being a part of this study.
I know that I may ask now, or at any time in the future, any questions I have about the study. I have been assured that the audio and written records related to this study will be kept confidential to the limits of the law. I have also been assured that no information will be released or printed or made public that would disclose my personal identity unless I give permission for that to happen.
I hereby consent to participate
Printed Name of Participant:
Date:
Signature of Participant:
I hereby consent to having my interview audio recorded
Signature of Participant:
Date:
Printed Name of Monitor:
Date:
Signature of Monitor:
Please Note: This research has been reviewed by the Human Participants in Research Committee, York University’s Ethics Review Board, and conforms to the standards of the Canadian Tri-Council Research Ethics guidelines and the York Senate Policy on research ethics. If you have any questions about this process, or about your rights as a participant in the study, please contact: Senior Manager & Policy Advisor for the Office of Research Ethics 4700 Keele Street, 5th Floor, York Research Tower, York University, Toronto, ON, Canada M3J 1P3; telephone: +1 416-736-5914; e-mail: ore@yorku.ca