CONSENT FORM
I have had the project explained to me, and I have read the information sheet
1.
I agree to participate in the research project as described
2.
I agree to be interviewed
3.
I acknowledge that:
(a)
(b)
(c)
(d)
I understand that my participation is voluntary and that I am free to withdraw from the project
at any time and to withdraw any unprocessed data previously supplied (unless follow-up is
needed for safety).
The project is for the purpose of research. It may not be of direct benefit to me.
The privacy of the personal information I provide will be safeguarded and only disclosed where
I have consented to the disclosure or as required by law.
The security of the research data will be protected during and after completion of the study.
The data collected during the study may be published, and a report of the project outcomes will
be provided to Whittlesea Community Connections. Any information which will identify me will
not be used.
Participant:
Date:
(Signature)
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