Saralrozgar Project: Consent Form for Human Research Ethics Committee

This document presents a consent form template designed for a Human Research Ethics Committee project, specifically referencing the 'Saralrozgar' project. The template includes sections for participant consent, covering aspects such as data confidentiality, use of aggregated results, and the right to withdraw from the study. It also incorporates a section for parental/guardian consent for participants under 18. The form emphasizes the importance of informed consent, ensuring that participants are fully aware of the research program and their rights. It also addresses the potential use of de-identified data in future research projects. This resource is valuable for understanding the structure and content required in a research consent form.

Consent Form
Human Research Ethics Committee
INSTRUCTIONS FOR PREPARING THE INFORMED CONSENT FORM (Attached):
 The attached template should be modified to be relevant to your project. Please add
to/modify/delete the information it contains to ensure that the consent form is relevant to your
project.
 The ‘Consent of Parent/Guardian’ section should only be included if participants in your project
will be under the age of 18. If your participants are adults, please delete this section.
 If you are not allocating code numbers to your participants, please delete the section that refers to
this.
 The consent form must be on a separate sheet of paper to the Plain Language Information
Statement. This is because the participants must be able to keep the PLIS.
 If you are video/audio recording interviews/focus groups with your participants, you must include
a clause whereby the participants agree to this.
 If you think you may wish to use the collected data in future research projects, be sure to inform
participants now that this is a possibility in both the Plain Language Information Statement (PLIS)
and on this consent form. This removes many obstacles for you in the future. Use wording in the
PLIS and consent forms like: 'Be aware that in participating in this research, your de-identified data
may be used to inform future research …' rather than '...only researchers named on this project
will have access to this data...'
PLEASE REMOVE THIS INSTRUCTION PAGE BEFORE ATTACHING YOUR CONSENT FORM TO YOUR
APPLICATION
CRICOS Provider No: 00103D V2 2017 0 | P a g e

Consent Form
Human Research Ethics Committee
PROJECT TITLE: Functional Analyzes of Campaign Management in Saralrozgar
RESEARCHERS: (Please fill)
(Delete this table if not relevant to your project)
Code number allocated
to the participant:
Consent – Please complete the following information:
I (please fill) of (please fill) + hereby consent to participate as a subject in the above research study.
The research program in which I am being asked to participate has been explained fully to me, verbally and in
writing, and any matters on which I have sought information have been answered to my satisfaction.
I understand that: all information I provide (including questionnaires) will be treated with the
strictest confidence and data will be stored separately from any listing that includes my name and address.
 Aggregated results will be used for research purposes and may be reported in scientific and academic
journals.
 I am free to withdraw my consent at any time during the study in which event my participation in the
research study will immediately cease and information/data obtained from it will not be used.
 I understand the exception to this is if I withdraw after information has been aggregated - it is unable to be
individually identified - so from this point it is not possible to withdraw my information/data, although I may
still withdraw my consent to participate.
SIGNATURE:_______ (please fill) ____________________________ DATE: _______(please fill)
_____________.
(delete this section below if not relevant to your project)
Consent of Parent/Guardian:
As parent/legal guardian,________________________, of ________________________________
__________________________(address) I give permission to the research team to approach my child
__________________________________(name of the child) and ask if he/she wishes to participate in
your project.
SIGNATURE:___________________________________ DATE:___________________
CRICOS Provider No: 00103D V2 2017 1 | P a g e