Consent Form – Fieldwork Research Methods for Japan I agree to participate in the following research project: Project Title: ____________________________________________________________________________________ Researcher Name: ______________________________________________________________________________ Research Project Summary: I understand … (please tick each line as appropriate) Research Project Outline: ____ this research project is for a Nanzan University Center for Japanese Studies (CJS) course called Fieldwork Research Methods for Japan ____ my participation in this research project is voluntary ____ I can withdraw my consent to participate at any time, verbally or in writing, without penalty ____ if I do withdraw my consent, any information I have already provided will be destroyed immediately and not used The Interview: ____ I will be interviewed ________ times for about _______ minutes each time ____ I will be interviewed about _________________________________________________________________________________________ ____ before and during the interview, I will have the opportunity to discuss and decide with the researcher what information I will provide ____ I do not have to answer questions that I do not want to answer Protecting my Personal Information: ____ the information I provide will be stored securely on a passwordprotected memory stick or in a locked drawer ____ this information will not be provided to a third party without my permission ____ the information I provide will be securely destroyed at the end of the course in December 2014 OR ____ I give permission for the researcher to keep my information for use in later research projects Releasing Results: ____ at the end of the course, the researcher will give a tenminute presentation to the other students of the class, and my information may be used ____ at the end of the course, the researcher will write a 2500word report/webpage, and my information may be used ____ the researcher might / will not use the information I provide in later research projects ____ my real name will / will not be used in the presentation and report / webpage, or in a later research project ____ my picture will / will not be used in the presentation and report / webpage, or in a later research project Your name: _______________________________________________ Signature or seal: ________________________ Phone number ___________________________________________ Date: _______________________________________ OR student number:

Consent form.english.v2

Download PDF Report

Upload
robert-croker
View
32
Download
1

Embed Size (px)

Citation preview

Consent Form – Fieldwork Research Methods for Japan I agree to participate in the following research project:

Project Title: ____________________________________________________________________________________

Researcher Name: ______________________________________________________________________________ Research Project Summary:

I understand … (please tick each line as appropriate)

Research Project Outline:

____ this research project is for a Nanzan University Center for Japanese Studies (CJS) course called Fieldwork Research Methods for Japan

____ my participation in this research project is voluntary ____ I can withdraw my consent to participate at any time, verbally or in writing, without penalty ____ if I do withdraw my consent, any information I have already provided will be destroyed immediately and not used The Interview:

____ I will be interviewed ________ times for about _______ minutes each time ____ I will be interviewed about _________________________________________________________________________________________ ____ before and during the interview, I will have the opportunity to discuss and decide with the researcher what

information I will provide ____ I do not have to answer questions that I do not want to answer Protecting my Personal Information:

____ the information I provide will be stored securely on a password-‐protected memory stick or in a locked drawer ____ this information will not be provided to a third party without my permission ____ the information I provide will be securely destroyed at the end of the course in December 2014 OR ____ I give permission for the researcher to keep my information for use in later research projects Releasing Results:

____ at the end of the course, the researcher will give a ten-‐minute presentation to the other students of the class, and my information may be used

____ at the end of the course, the researcher will write a 2500-‐word report/webpage, and my information may be used ____ the researcher might / will not use the information I provide in later research projects ____ my real name will / will not be used in the presentation and report / webpage, or in a later research project ____ my picture will / will not be used in the presentation and report / webpage, or in a later research project Your name: _______________________________________________ Signature or seal: ________________________ Phone number ___________________________________________ Date: _______________________________________ OR student number: