Online Assessment Consent Form
Please review the information below and provide your consent to participate in the online assessment.
Participant Information
Please provide your personal details below.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Assessment Details
Tell us about your upcoming assessment.
Type of Assessment
*
Please Select
Skills Assessment
Personality Assessment
Knowledge Test
Other
Preferred Assessment Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
How comfortable do you feel using online platforms for assessments?
*
Not comfortable
1
2
3
4
Very comfortable
5
1 is Not comfortable, 5 is Very comfortable
Please indicate your agreement with the following statements regarding the online assessment.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I understand the purpose of the assessment.
1
2
3
4
5
I am aware that my participation is voluntary.
6
7
8
9
10
I understand that my responses will be confidential.
11
12
13
14
15
I am aware I can withdraw at any time without penalty.
16
17
18
19
20
Do you have any accessibility needs or require special accommodations for the assessment?
*
No, I do not require any accommodations.
Yes, I require accommodations (please specify below).
If you require accommodations, please describe them here.
Signature (Please sign below to confirm your consent)
*
Submit Consent
Submit Consent
Should be Empty: