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JASIRI Consent Form

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prosperhagenimana250
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29 views2 pages

JASIRI Consent Form

Uploaded by

prosperhagenimana250
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
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INFORMED CONSENT FORM

What is the information collected for?


The information we collect will form part of the baseline and follow-up data on
programmatic and individual-level progress. Please note that we do not require
respondents to share their personal names, identity numbers, physical addresses, or
any other identifiable information.

What is the purpose of data collection?


The information we collect will help JASIRI in the planning, monitoring, and
evaluation of any program or event.

What do I need to do for any survey?


If you agree, we will ask you questions specific to programmatic, personal progress,
and general feedback of various programs. Most surveys should take about 10 to 30
minutes to complete.

What will happen to my information?

We will not share your information with anyone who is not part of the survey team.
A team of data analysts who are aware of data privacy and protection policies will
analyze your information. Your information will be kept in a database that is secured
with password protection so only individuals directly involved can access the
information. At the end of the evaluation, your information will be destroyed.

What if I do not want to take part in data collection activities?


Taking part in this evaluation is voluntary. You do not have to answer any question
that you do not want to.

What are the benefits of being part of data collection activities?


The information you provide will help us learn on how to better serve you in the
future.

What are the risks of being part of Jasiri’s data collection activities?
There is a slight risk of your personal information unintentionally being revealed to
those outside the survey team. We will keep the information you provide private to
the extent allowed by law.

Are there any costs or payments for participating in Jasiri’s data collection
activities?
There is no cost for you to be in this evaluation.

Hagenimana Prosper 11/14/2024


Full Name: _____________________Date:_____________Signature:_____________
VIDEO/PHOTOGRAPH RELEASE CONSENT FORM

I hereby grant JASIRI the irrevocable right and permission to use photographs and/or
video recordings of me on websites, publications, promotional flyers, educational
materials, derivative works, or for any other similar purpose without compensation to
me.

I understand and agree that such photographs and/or video recordings of me may
be placed on the Internet.

I also understand and agree that I may be identified by name and/or title in printed,
Internet or broadcast information that might accompany the photographs and/or
video recordings of me.

I waive the right to approve the final product. I agree that all such portraits, pictures,
photographs, video and audio recordings, and any reproductions thereof, and all
plates, negatives, recording tape and digital files are and shall remain the property of
JASIRI and the wider Allan & Gill Gray Philanthropy (AGGP) group.

I hereby warrant that I am eighteen (18) years old or more and competent to contract
in my own name or, if I am less than eighteen years old, that my parent or guardian
has signed this consent form below. This consent is binding on me and my heirs,
assigns and personal representatives.

Hagenimana Prosper 11/14/2024


Full Name: _____________________Date:_____________Signature:_____________

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