Consent Form for Research Study

Consent Form:
For: (Please enter the name of the target group)
Name of the department:
Title of the study:
Having understood the title and purpose of the research, I hereby state that I have understood
all the information conveyed to me about the research project. I also state that I have clearly
understood my role in the research project by reading the information that was provided in
the participation information speech. (Dated: .............)
I further confirm that I had the complete opportunity to ask questions for the clarification of
my doubts regarding the research. The researcher had cleared all my queries related to the
research study to the optimum level of satisfaction.
I understand that the research would involve the research conducting an interview with me as
a participant. Further, I am aware that the interview process would only involve me and the
researcher and the process would last for 30 minutes. I understand the researchers would
audiotape my responses which would be coded and would be used for the experimental
purpose only.
I further understand that my participation in the research study is voluntary and at any point
of the research I can withdraw myself from the research. I also understand that I am not
entitles to mention any reason for withdrawing my name and I won’t be held responsible for
the consequences.

I also acknowledge that I am extending my consent to the researchers to use my personal data
for the research study. However, I am only extending my consent to the researcher to use my
personal data and expect my name and other details to be kept anonymous.
I acknowledge that I am aware of the legal implication that the researcher is entitled to face
on violating the privacy norms and breaching my confidentiality. I was able to learn about the
legal implication of the violation of privacy law through the information published on the
participation booklet.
Name of the researcher,
Department of Psychology
Room No.
Address
Signature of participant:
Date: