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, and my information may be used. ____ my real name can / cannot be used in the presentation and report. ____ my picture can / cannot be used in the presentation and report. ____ the researcher can / cannot use the information I provide in later research projects. Your name: _______________________________________________ Signature or seal: ________________________ Phone number: ___________________________________________ Date: ______________________________________ OR student number:

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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, and my information may be used. ____ my real name can / cannot be used in the presentation and report. ____ my picture can / cannot be used in the presentation and report. ____ the researcher can / cannot use the information I provide in later research projects. Your name: _______________________________________________ Signature or seal: ________________________ Phone number: ___________________________________________ Date: ______________________________________ OR student number: