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Consent Forms For Adults

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46 views3 pages

Consent Forms For Adults

Uploaded by

Mmex
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

Catholic Relief Services

P.O. Box 6592


Addis Ababa, Ethiopia
Tel : 251 – 11 -278 8800
Fax : 251 – 11 – 278 8822
E-mail : [email protected]

CONSENT FORM - Adults

1. Invitation to participate: You have been invited to participate in a study about food insecurity.
This research is being conducted by Catholic Relief Services via Untold Research and Charima
Research. The purpose of this research is to understand how food insecurity is affecting Ethiopian’s
youth and explore outstanding need gaps.

You will be asked to:


• Participate in a survey. The interviewer will ask you a series of questions on your family’s
experiences with food insecurity.
• Answer simple questions about you as part of demographics characteristics.

2. Description of the Study:


We are asking adolescents age 15-19 and youth age 20-35 years in selected regions of Ethiopia their
experiences with food security. Charima Research, under the supervision of Untold Research, team
will be responsible for the data collection. A team composed of trained interviewers will conduct the
assessment, which should not take more than 30 minutes.

3. Risks and inconveniences: This study represents minimal risks to you. The primary risk is feeling
discomfort while speaking to an interviewer. If you don’t feel comfortable answering a question, you
might skip it.

4. Benefits:
This evaluation may not benefit you directly. However, by answering you may contribute to improved
programs working to alleviate food insecurity throughout Ethiopia, particularly among youth.

5. Confidentiality:
All information obtained during the study will be confidential. Your privacy will be protected at all
times. You will not be identified individually in any way as a result of your participation in this evaluation.
The data collected, however, will be used in reporting.

6. Voluntary participation: If you have read this form and decided to participate in this project,
please understand your participation is voluntary and you have the right to withdraw consent or
discontinue participation at any time without penalty. The results of this research study may be
presented at scientific or professional meetings or published in scientific journals.

Page 1 of 3

The Overseas Relief and Development Agency of the United States Conference of Catholic Bishops
Catholic Relief Services
P.O. Box 6592
Addis Ababa, Ethiopia
Tel : 251 – 11 -278 8800
Fax : 251 – 11 – 278 8822
E-mail : [email protected]

7. Financial (or other) considerations: _________________________________________

8. Other considerations and questions: Please feel free to ask any questions about anything that
seems unclear to you and consider this evaluation and consent form carefully before you sign.

Authorization: Consent from parent or guardian

I have read or listened to the above information and I have decided to participate in the research described
above. The interviewer has explained the evaluation to me and answered my questions. I understand the
purpose of this research is to document experiences of youth when it comes to food insecurity in Ethiopia. If I
do not participate, there will be no penalty or loss of rights. I can refuse to respond to some questions and/or
stop participating at any time, even after we have started. I have been told that this survey will take no more
than 30 minutes. If I am not able to read, I have been given the chance to appoint someone to read for me
the consent form.

My signature below indicates I am older than 18 years and I agreed to participate.

Adult’s signature: _____________________________________

Adult’s Name: ________________________________________________________

Date: ____________________________

My signature below indicates this individual adult has agreed to participate in this study.

Data collector’s signature: _____________________________________________________

Data collector’s name: ________________________________________________________

Date: ____________________________

If you have further questions about this research project, please contact the Principal Investigator:

______________________________________________________________________

Page 2 of 3

The Overseas Relief and Development Agency of the United States Conference of Catholic Bishops
Catholic Relief Services
P.O. Box 6592
Addis Ababa, Ethiopia
Tel : 251 – 11 -278 8800
Fax : 251 – 11 – 278 8822
E-mail : [email protected]

If you have questions about your rights as a research participant or if you have a relevant complaint please
contact: _________________________________________________________

Page 3 of 3

The Overseas Relief and Development Agency of the United States Conference of Catholic Bishops

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