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Informed Consent Form Example
This is an example type of informed consent form for projects not dealing with medical research,
children & young adults, people with learning difficulties, crime, internet research and/or research
within organisation/workplace.
I, the undersigned, confirm that (please tick box as appropriate):
1. I have read and understood the information about the project, as provided in the
Information Sheet dated ________________. 
2. I have been given the opportunity to ask questions about the project and my
participation. 
3. I voluntarily agree to participate in the project.

4. I understand I can withdraw at any time without giving reasons and that I will not be
penalised for withdrawing nor will I be questioned on why I have withdrawn. 
5. The procedures regarding confidentiality have been clearly explained (e.g. use of
names, pseudonyms, anonymisation of data, etc.) to me. 
6. If applicable, separate terms of consent for interviews, audio, video or other forms of
data collection have been explained and provided to me. 
7. The use of the data in research, publications, sharing and archiving has been explained
to me. 
8. I understand that other researchers will have access to this data only if they agree to
preserve the confidentiality of the data and if they agree to the terms I have specified
in this form.

9. Select only one of the following:
• I would like my name used and understand what I have said or written as part
of this study will be used in reports, publications and other research outputs so
that anything I have contributed to this project can be recognised.
• I do not want my name used in this project.


10. I, along with the Researcher, agree to sign and date this informed consent form.

Participant:
________________________ ___________________________ ________________
Name of Participant Signature Date
Researcher:
________________________ ___________________________ ________________
Name of Researcher Signature Date

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Consent form example

  • 1. Informed Consent Form Example This is an example type of informed consent form for projects not dealing with medical research, children & young adults, people with learning difficulties, crime, internet research and/or research within organisation/workplace. I, the undersigned, confirm that (please tick box as appropriate): 1. I have read and understood the information about the project, as provided in the Information Sheet dated ________________.  2. I have been given the opportunity to ask questions about the project and my participation.  3. I voluntarily agree to participate in the project.  4. I understand I can withdraw at any time without giving reasons and that I will not be penalised for withdrawing nor will I be questioned on why I have withdrawn.  5. The procedures regarding confidentiality have been clearly explained (e.g. use of names, pseudonyms, anonymisation of data, etc.) to me.  6. If applicable, separate terms of consent for interviews, audio, video or other forms of data collection have been explained and provided to me.  7. The use of the data in research, publications, sharing and archiving has been explained to me.  8. I understand that other researchers will have access to this data only if they agree to preserve the confidentiality of the data and if they agree to the terms I have specified in this form.  9. Select only one of the following: • I would like my name used and understand what I have said or written as part of this study will be used in reports, publications and other research outputs so that anything I have contributed to this project can be recognised. • I do not want my name used in this project.   10. I, along with the Researcher, agree to sign and date this informed consent form.  Participant: ________________________ ___________________________ ________________ Name of Participant Signature Date Researcher: ________________________ ___________________________ ________________ Name of Researcher Signature Date