Simple Informed Consent Form

Simple Informed Consent Form
A Qualitative Research on Transfer Information
Leading to Misinformation

Investigator: John Doe
Department: Social Sciences Department
Fund Source: Go Fund Me
PURPOSE OF THE STUDY
You are invited to take part in a research study. But before you accept, we would like to help you understand the research and what participation you will be involved in. Please read through this informed consent and feel free to let us know if you need some clarifications.
STUDY PROCEDURES
Should you wish to participate, we will ask you for your personal information and your educational background. Then, you will answer a series of psychological questions in order to evaluate which category you belong to. Then you will be asked another series of analytic questions about your opinion on certain matters.
We will be asking about 300 individuals to take part in this study.
You need not worry about privacy as we will not share the information we have gathered from this study other than statistical and non-identifiable personal information.
DURATION
This study will take more or less 5-10 minutes per individual consisting of the quick personal interview which takes more or less about 1-2 minutes, and the rest for the answering of the survey questionnaire.
VOLUNTARY PARTICIPATION
Please understand that your participation here is purely voluntary. You will decide whether you will participate or not. In case you decide to participate, you will be required to fill out the fields below for your consent as an affirmation of your participation. Should you decide to withdraw during the study, please do inform us. Your withdrawal will not affect your relationship with us. In case you withdraw from this study before completion of the data collection, all information, including the consent will be deleted.
CONTACT INFORMATION
This study was approved by the Social Sciences Department. If you have questions or concerns about this study, you can get in touch with the Social Sciences Department Director at the email address director@example.com or by phone at 111-1111.
CONSENT
I voluntarily give my consent to participate in this study. I have read the information above or the said information was read to me. I was given the opportunity to ask questions and these were answered satisfactorily and to my contentment.
Is the participant illiterate?
Yes
Name of Participant
First NameLast Name
Date
MonthDayYear
Date
Signature of Participant
Clear
I have witnessed before me the reading of the informed consent form accurately. The participant named herein has had the opportunity to ask questions. On behalf of the participant, I confirm that the said participant has given consent to freely participate in this study.
Name of Representative
First NameLast Name
Date
MonthDayYear
Date
Signature of Representative
Clear
Name of Witness
First NameLast Name
Date
MonthDayYear
Date
Signature
Clear
Name of Reseracher
First NameLast Name
Date
MonthDayYear
Date
Signature
Clear
Should be Empty: