Sample Consent Form: Focus Groups

Sample Consent Form: Focus Groups

[Title of Study]
[Name of AllResearcher(s)]
[Name of Department]
Mount Allison University

I am [a faculty member/honours student/directed studies student/etc.] in the Department of [Sociology/Psychology/Biology/etc.] at Mount Allison University. [For student research, insert: “As part of my masters/honours thesis/directed studies project/etc., I am conducting research under the supervision of Dr.______, and…”] I am inviting you to participate in my study. The purpose of the study is to examine [insert a concise one or two sentence overview of your study.]

This study involves [insert a paragraph explaining the process or methods of your study. Include: what the participants can expect during the study; the approximate time to complete the study, etc.].

[Insert any benefits or potential risks of participating in this study]. Your participation is completely voluntary. You may withdraw from this study at any time without penalty.

[Insert some text here about confidentiality. In most cases, you will want to assure your participants of the confidentiality of their participation and responses. This means that you are not telling other people that these individuals participated, and you are not telling other people what their responses were, except to those who are part of your research team or, in the case of students, to your supervisor. Of course you will be reporting the results of your research findings, presentations, and publications. There may be instances where keeping confidentiality is not possible, and in the context of your particular project, you may need to say that you will keep the information confidential to the extent that the law permits (such as being subpoenaed by a court of law to testify about illegal activities), or that if they tell you something about plans to injure themselves or others, that you will have to report it.]

All participants will be asked not to disclose anything said within the context of the discussion. By agreeing to participate, you agree to not disclose to others outside this event anything said within the context of the discussion. All identifying information will be removed from the collected materials, and all materials will [explain how records will be stored securely].

[Depending on the nature of your study and how you choose to conduct your focus groups, you may have an interest in quoting people or in referring generally or specifically to individuals (by the organization they represent, for example), in your reports and publications. If it is your intention to NOT use any names and to NOT refer to individuals, then you should say something about your intention to keep the information they share anonymous and that you will not refer to individual people at all. Please keep in mind that individuals such as public officials who could be identified by the nature of their position, or individuals who could be identified by their unique characteristics within a small population, cannot necessarily be guaranteed anonymity.If you think you might want to quote or refer to individuals specifically, you can skip saying anything about anonymity but be sure to obtain their permission to quote, as below.]

Permission to Quote:

I may wish to quote your words directlyin reports and publications resulting from this. With regards to being quoted, please check yes or no for each of the following statements:

Researchers may publish documents that contain quotations by me under the following conditions:
Yes No / I agree to be quoted directly (my name is used).
Yes No / I agree to be quoted directly if my name is not published (I remain anonymous).
Yes No / I agree to be quoted directly if a made-up name (pseudonym) is used.

By signing this consent form, you are indicating that you fully understand the above information and agree to participate in this study.

Participant's signature ______

Date: ______

Researcher's signature: ______

Date: ______

If you have any questions about this study, please contact [for student research, the student's name, phone number, and e-mail address, and the faculty supervisor's name, phone number, and e-mail address]. This research has been reviewed and approved by the Mount Allison University Research Ethics Board. If you have any questions or concerns about this study, you may contact Dr. Odette Gould, Chair of the Mount Allison University Research Ethics Board, by phone (506-364-2618) or by e-mail at .