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RESEARCH CONSENT FORM

Qualitative Research on the (Insert Topic) Investigator: (Name of student), (Contact details)

This is a research study, participation is voluntary, and you can ask questions at any time. PURPOSE OF STUDY •The purpose of this study is to conduct a qualitative investigation into the (brief description of topic). You qualify as potential participant for this study based on (insert reason for eligibility). There will be approximately (insert number of) participants in this study. PROCEDURES •This study will utilize an interview structure in which you will be asked a series of questions regarding (insert details). There is the potential for a therapeutic effect to take place during this process and discussion of personal experiences. If you feel uncomfortable during the interview process you have the right to decline to answer or terminate the interview. •You will be interviewed by (insert student name). The interview should last approximately 30 minutes. An audio recording of the interview may be conducted for accurate data collection and recollection. If you do not wish to be taped you can decline to participate in this study. •You will be an anonymous participant in this project. Your name and identity will not be used on any recorded materials presented from information obtained during the interview process. •All audio and written recordings will be encrypted and stored on a secure network. After the completion of this project all collected material will be disposed in a secure and confidential manner. POTENTIAL RISKS/DISCOMFORTS: • Due to the unknown nature of your individual experience there is the potential of discomfort involving the recollection of (state reason if applicable. Remove sentence if this is not relevant). If at anytime you feel uncomfortable you may terminate your involvement with this study. I have read and understand the explanation provided to me. I have had all my questions answered to my satisfaction, and I voluntarily agree to participate in this study. Participant Signature Printed Name Date