PARTICIPANT CONSENT FORM
Title of the Study: [Your initial title]
Interviewer: [Your Name (only one name of anyone from the group)] et. al.
______________________________________________________________________________________________
Greetings of Peace!
You are invited to participate in a research study on disaster preparedness and response
strategies for government agencies. The purpose of this study is to [Objectives of the Study].
Your participation in this study is entirely voluntary, and you may choose to withdraw at any
time without consequence.
If you agree to participate, you will be asked to complete a recorded interview. The
recorded interview will inquire about your perception, insights and experiences regarding
[your topic]. The survey should take approximately 15 to 20 minutes to complete. Your
responses will be anonymized and used solely for research purposes.
There are minimal risks associated with participating in this study. You may experience
mild discomfort or inconvenience while completing the survey questionnaire. However, your
responses will remain confidential, and every effort will be made to ensure your privacy is
protected. The benefits of participating in this study include contributing to the advancement
of knowledge on [your topic] and potentially developing [your prototype].
Your responses will be kept strictly confidential and will not be shared with anyone
outside of the research team. All data collected will be stored securely and accessed only by
authorized personnel. Any identifiable information will be removed or anonymized to protect
your privacy.
Participation in this study is entirely voluntary. You are under no obligation to
participate, and your decision will not affect your relationship to any stakeholders. If you
choose to participate, you may withdraw at any time without penalty by simply returning the
form.
If you have any questions or concerns about the study, you may contact the principal
investigator, [Your Name], at [Your Contact Information].
______________________________________________________________________________________________
Acknowledgement of Consent:
By signing below, you acknowledge that you have read and understood the information
provided in this consent form. You voluntarily agree to participate in the study and consent to
the use of your responses for research purposes.
Participant's Signature: _______________________________________Date: ____________________
