STELLENBOSCHUNIVERSITY

ELECTRONIC CONSENT TO PARTICIPATE IN RESEARCH

TITLE OF RESEARCH PROJECT: / _____
REFERENCE NUMBER: / _____(for example: ING-2018-0429)
PRINCIPAL INVESTIGATOR: / _____(student name)
ADDRESS: / _____(name and physical address of academic department)
CONTACT NUMBER: / _____(student contact number)
E-MAIL: / _____(student email address)

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Dear_____(prospective participant, colleague, fellow teacher,fellow student, parent,etc)

Kindly note that I am a_____(MEng/BEng) student at the Department of _____ at Stellenbosch University, and I would like to invite you to participate in a research project entitled_____.

Please take some time to read the information presented here, which will explain the details of this project and contact me if you require further explanation or clarification of any aspect of the study. This study has been approved by the Research Ethics Committee (REC) at Stellenbosch University and will be conducted according to accepted and applicable national and international ethical guidelines and principles.

Please include the following details and make use of these sub-headings for ease of use:

  1. INTRODUCTION: _____ (A short introduction to the study.)
  2. PURPOSE: _____ (The purpose/aim of the study… what the study is designed to assess or establish.)
  3. PROCEDURES: _____ (The various procedures of the study… what would be expected from a prospective participant.)
  4. TIME: _____ (Please specify the length of time to participate in 1) each procedure, or 2) the total study.)
  5. RISKS: _____ (Please specify any potential risks, discomforts, or inconveniences with regards to participation.)
  6. BENEFITS: _____ (Please specify any potential benefits with regards to participation.)
  7. CONFIDENTIALITY: _____ (Please specify the measures that will be taken to ensure confidentiality of participant details. Please also specify the measure that will be taken to ensure confidentiality of collected data.)
  8. RECORDINGS: _____ (Please specify if voice or video recordings of interviews will be made use of.)
  9. DATA STORAGE: _____ (Please include details as to issues relating to how and where data will be stored, if it will be anonymised, coded or identifiable, who will have access to it, whether or not data sharing is envisaged, etc.)

If you have any questions or concerns aboutthis research project, please feel free to contact_____. (As the principal investigator, please insert your name, surname, email address and cell phone number. If you are a student please also insert the name, surname and email address of your supervisor.)

RIGHTS OF RESEARCH PARTICPANTS: You may withdraw your consent at any time and discontinue participation without penalty. You are not waiving any legal claims, rights or remedies because of your participation in this research study. If you have questions regarding your rights as a research subject, contactMs Maléne Fouché( / 021808 4622) at the Division for Research Development. You have the right to receive a copy of this Consent form.

If you are willing to participate in this research project, please select the relevant box in the Declaration of Consent below and_____.(i.e. hand it to the investigator, place it in the box available, etc)

DECLARATION BY THE PARTICIPANT

As the participant I hereby declare that:

  • I have read the above information and it is written in a language with which I am fluent and comfortable.
  • I have had a chance to ask questions and all my questions have been adequately answered.
  • I understand that taking part in this study is voluntary and I have not been pressurised to take part.
  • I may choose to leave the study at any time and will not be penalised or prejudiced in any way.
  • If the principal investigator feels that it is in my best interest, or if I do not follow the study plan as agreed to, then I may be asked to leave the study before it has finished.
  • All issues related to privacy, and the confidentiality and use of the information I provide, have been explained to my satisfaction.

As the participant I herebyselect the following option:

I acceptthe invitation to participate in your research project, and if I decide to be interviewed it would automatically mean that I have given consent for my responses to be used confidentially and anonymously.
I accept the invitation to participate in your research project, and if I decide to completethequestionnaireit would automatically mean that I have given consent for my responses to be used confidentially and anonymously.
I decline the invitation to participate in your research project.
DECLARATION BY THE PRINCIPAL INVESTIGATOR

As the principal investigator Ihereby declare that the information contained in this document has been thoroughly explained to the participant. I also declare that the participant has been encouraged(and has been givenample time) to ask any questions. In addition I would like to select the following option:

Theconversation with the participant was conducted in a language in which the participant is fluent.
The conversation with the participant was conducted with the assistance of a translator, and this “Consent Form” is available to the participant in a language in which the participant is fluent.

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Signed at (place) Date

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Signature of Principal Investigator