Survey Consent Form

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A survey consent form is used by researchers to provide details regarding a survey they invited individuals to participate in and gather their consent. The form allows participants to decide whether they wish to participate in the survey and includes details about the survey’s purpose, how long it will take to complete, and how the information will be used.

Survey Consent Form

A survey consent form is used by researchers to provide details regarding a survey they invited individuals to participate in and gather their consent. The form allows participants to decide whether they wish to participate in the survey and includes details about the survey’s purpose, how long it will take to complete, and how the information will be used.

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Last updated October 21st, 2024

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A survey consent form is used by researchers to provide details regarding a survey they invited individuals to participate in and gather their consent. The form allows participants to decide whether they wish to participate in the survey and includes details about the survey’s purpose, how long it will take to complete, and how the information will be used.

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When To Use

This form is useful when research includes surveys collecting data from human participants conducted online, in-person, or via email. It may used by:

  • Researchers in academic institutions
  • Market research firms
  • Private companies
  • Independent researchers
  • Government agencies*

What to Include

Generally, a survey consent form for research includes the following elements:

  1. Title and Purpose. The name of the study and a summary of why the survey and study is being conducted should be included in the form.
  2. Procedures. The form should describe what the individual will do in the survey if they participate.
  3. Risks/Benefits. The form should outline any potential risks or benefits. Even if the survey does not actually offer any real risks or benefits to the participant, this should be stated.
  4. Compensation. Any compensation offered should be stated in the form. Otherwise, a statement indicating the participant will not be compensated may be included.
  5. Confidentiality. The participant should be informed that the data received is anonymous, that their personal information will not be collected, and that the results may be published or presented.
  6. Voluntary Participation. A statement saying the individual may end their participation at any time during the survey should be included.
  7. Questions. The participant should be given the contact information of a member of the research team or another individual able to answer their questions.

Sample

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SURVEY CONSENT FORM

Study Title: [TITLE]
Researcher: [PRINCIPAL INVESTIGATOR NAME], [INSTITUTION]

I/We are asking you to be in this research study because [DESCRIBE ELIGIBILITY]. You must be age 18 or older to participate in the study. The information in this consent form is to help you decide if you want to be in this research study. Please take your time reading this form and contact the researcher(s) to ask questions if there is anything you do not understand.

1. PURPOSE. The purpose of the research study is [DESCRIBE STUDY PURPOSE].

2. PROCEDURE. If you agree to be in this study, you will complete a survey. The survey includes questions about [DESCRIBE QUESTIONS/THEMES] and should take you about [APPROXIMATE LENGTH] to complete.

3. RISKS/BENEFITS. It is unlikely that you will experience any risks or discomforts beyond what would be experienced in everyday life by participating. There are no specific benefits associated with participating.

4. COMPENSATION. You will be offered compensation in the form of [ENTER COMPENSATION OR N/A].

5. CONFIDENTIALITY. The data collected in this study are completely anonymous. No personally identifiable information will be collected, and the information you choose to provide in this study cannot be connected to you. Results from this study may be published or presented at research conferences, and the anonymous data may be shared with other researchers through an online data repository.

6. VOLUNTARY PARTICIPATION. Your participation in this study is voluntary, and you may choose not to participate or end your participation at any time without penalty.

7. QUESTIONS. If you have any questions about this study, you may contact [CONTACT NAME] by phone at [CONTACT PHONE #], or by email at [CONTACT EMAIL ADDRESS].

8. CONSENT. I have read and understand the above consent form. I certify that I am 18 years old or older.

Participant Signature: ____________________________ Date: [DATE]
Print Name: [PARTICIPANT’S PRINTED NAME]

Sources

  1. § 46.101(a)