2322 ENG MOD

Interview Assignment

for ENG 2322: Research Writing

Consent Form

My name is _______________and I am a student at Indiana Institute of Technology (Indiana Tech). I am enrolled in a course called Research Writing. My instructor, ____________________, has assigned an activity in which we practice our interviewing skills.

I am asking you to participate in a brief interview. The focus of the interview is _______________________________________________________________

The interview will take place at a location convenient to you or over the phone. It will take place for approximately ____ minutes. If you consent to it, I will record the interview using a digital audio recorder. Excerpts from the interview may be included in a paper for the course assignment or may be discussed during class. This interview is not being used for a research purposes.

Your participation in this interview is completely voluntary, and you are free to stop at any time or to decline to answer a question.

If you have any questions about this study, you may contact my instructor ____________ at (xxx) xxx-xxxx or at ​__________________.

There are two copies of this letter. After signing them, keep one copy for your records and return the other one. Thank you in advance for your cooperation and support.

Please indicate your agreement to participate by signing below.

I am 18 years or older and have read and understood this consent form and agree to participate in the interview.

___ Yes ___ No

I agree to have the interview digitally audio recorded.

___ Yes ___ No

Signature: ___________________________________________

Name: ___________________________________________ (Please Print)

Date: ___________________________________________