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14 Consent Template - 2020 - FID REC

The document is an Individual Consent form for research participation from the Faculty of Informatics and Design. It outlines the study's purpose, confidentiality assurances, data conservation methods, and voluntary participation rights. Participants can stipulate conditions regarding the use of their image, name, and words, and must sign to indicate their agreement to participate.

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5 views2 pages

14 Consent Template - 2020 - FID REC

The document is an Individual Consent form for research participation from the Faculty of Informatics and Design. It outlines the study's purpose, confidentiality assurances, data conservation methods, and voluntary participation rights. Participants can stipulate conditions regarding the use of their image, name, and words, and must sign to indicate their agreement to participate.

Uploaded by

lindokuhlediana146
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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FID/REC/ICv0.

FACULTY OF INFORMATICS AND DESIGN

Individual Consent for Research Participation

Title of the study: <<your title, as per HDC 1.2>>

Name of researcher: <<your name>>


Contact details: email: phone:

Name of supervisor: <<main supervisor>>


Contact details: email: phone:

Purpose of the Study: <<fill in – derived from the studies ‘aims’ statement>>

Participation: My participation will consist essentially of <<fill in, e.g. interviewee, tester
etc.>>

Confidentiality: I have received assurance from the researcher that the information I will share
will remain strictly confidential unless noted below. I understand that the contents will be used
only for <<fill in, e.g. M Tech thesis, journal article etc. >> and that my confidentiality will be
protected by <<fill in>> (explain how the confidentiality will be protected, e.g. use of
pseudonyms etc).

Anonymity will be protected in the following manner (unless noted below) <<fill in>>
(Describe how anonymity will be guaranteed, e.g. if photos are being used, the blanking out of
faces and/or places names. If anonymity cannot be protected, state this expressly, explain the
reason why and explain the risks involved for the participant, the organization, etc).

Conservation of data: The data collected will be kept in a secure manner <<fill in>> (Describe
how and where the data will be stored, who will have access to it, and how long it will be
conserved, e.g. digitally recorded interviews will be encrypted and kept in a password controlled
environment. Note: original data or a copy of the data should be kept for audit purposes).

Voluntary Participation: I am under no obligation to participate and if I choose to participate, I


can withdraw from the study at any time and/or refuse to answer any questions, without suffering
any negative consequences. If I choose to withdraw, all data gathered until the time of withdrawal
will destroyed. <<Change ‘destroyed’ to something else if negotiated with the participant. Get the
participant to initial the change if done by hand.>>

1
Additional consent: I make the following stipulations (please tick as appropriate):

In thesis In research Both Neither


publications
My image may
be used:

My name may be
used:

My exact words
may be used:

Any other
(stipulate):

Acceptance: I, (print name)_______________________________________________________

agree to participate in the above research study conducted by <<fill in>> (name of researcher) of
the Faculty of Informatics and Design <<fill in>> (name of Department) at the Cape Peninsula
University of Technology, which research is under the supervision of <<fill in>> (name of
supervisor).

If I have any questions about the study, I may contact the researcher or the supervisor. If I have
any questions regarding the ethical conduct of this study, I may contact the secretary of
the Faculty Research Ethics Committee at 021 469 1012, or email [email protected].

Participant's signature: ____________________________ Date: ____________________

Researcher's signature: _____________________ Date: ____________________

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