This is a tool to assist you in writing your consent form, but individual researchers hold the final responsibility for clarity and completeness.  If you have questions please feel free to contact the REB Co-ordinator, Sue Funk, or one of the REB Co-Chairs.

  • Use simple lay language aimed at a grade eight reading level. Explain any technical terms. Write out all acronyms the first time they appear on each page.
  • Number the pages, i.e., 1 of 3, 2 of 3, 3 of 3, etc.
  • Include a date as header or footer on every page.  If you make changes in the consent form, you must change the date which then signifies the version number.
  • All information required by the research participant must be included in the consent form.  Do not use attachments or additional information forms.
  • The consent form submitted for review should be in its final form (as it will be seen by the research participant), including letterhead if used. Photocopied letterhead is okay.
  • Spelling and grammar must be corrected before submission for review.
  • The consent form should be written in the second person (use "you" not "I"). The form is being written to the research participant.
  • When submitting revised consent forms to the REB please highlight any changes, whether originating with the investigators or requested by the REB.
  • Any changes to the application or consent form must be approved by the REB before the research begins or continues.
  • A copy of the consent form should be left with the participant (this copy is not required to have spaces for signatures).

CONSENT FORM

The following is a template and is not meant to be copied verbatim.  There are sections that should be modified to suit your research project.

Date (in header or in footer)

Title of your Study

Principal Investigator:  Name, Department, Institution, contact telephone number, and contact email address.

Be sure that "Principal" is not misspelled "Principle". Students must include the name, telephone number and email address of their supervisor or instructor. Students should identify themselves as such and include the degree and department, as well as indicating whether the research is part of a thesis (public document) or major project (semi-public document).   

Co-Investigator(s):  Name, Department, Institution, contact telephone number, and contact email address.

Purpose:  Explain in simple lay terms exactly the purpose of the research.  It may also be appropriate to provide an explanation of why they have been asked to participate.

Procedures:  Explain in simple lay terms exactly what will happen to participants if they participate in the study.

If applicable describe how many sessions or visits, amount of time required for each visit, amount of time required for interviews, questionnaires, etc. Provide details about any plan to contact participants for follow-up sessions or subsequent related study. Include a statement of whether or not research findings will be available to participants and how/where they will be made available to participants.

Potential Risks and Discomforts:  Describe any reasonably foreseeable risks, discomforts, inconveniences (including, for example, physical, psychological, emotional, financial and social), and how these will be managed.

If there are significant physical or psychological risks to participants that might cause the researcher to terminate the study, please describe them.

Potential Benefits to Participants and/or to Society:  Describe benefits to participants expected from the research.  If the participant will not benefit from participation, clearly state this fact. State the potential benefits, if any, to science or society expected from the research.

Confidentiality:  Include a statement such as "Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission or as required by law."  Describe how this will be accomplished; e.g., "All documents will be identified only by code number and kept in a locked filing cabinet. Research participants will not be identified by name in any reports of the completed study." Or "Data will be collected anonymously and names will not be linked with any information."

If the data records are kept on a computer hard disk, describe how the security of the computer record will be maintained. Describe length of retention. Note: Do not say that the information will be kept confidential, since it might be published.  If data will be stored anonymously for future use, that must also be stated.

Remuneration/Compensation:  State any remuneration or compensation for travel, etc.

If course credit is available to University students, explain the process. Remuneration or compensation should not be dependent on completion of the project, but should be pro-rated for those that withdraw before completion.  If names are entered for a draw you may not exclude the names of those who fail to complete the project (otherwise you are technically running a lottery).

Contact for information about the study:  If you have any questions or desire further information with respect to this study, you may contact (Principal Investigator) or one of (his/her) associates at (telephone number, email address).  (Refer to associates only if that's applicable to your research study.)

Contact for concerns about the rights of research participants:  If you have any concerns about your treatment or rights as a research participant, you may contact Elizabeth Kreiter in the Office of Research, Trinity Western University at 604-513-2167 or researchethicsboard@twu.ca.

Consent:  Your participation in this study is entirely voluntary and you may refuse to participate or withdraw from the study at any time without jeopardy to your ... (examples: employment, class standing, access to further services from the community centre, day care, etc.).

Also include a statement indicating the steps to be taken in order to withdraw from the study along with a clear indication of any point after which withdrawal is no longer possible.  This would be a point in the study in which is it not possible for the researcher to identify the research participants’ responses in order to remove them.  For example, if the participants were filling out an online survey where no identifying data was being collected, once the collection period for the survey had ended and the survey was closed to new submissions, there would be no way for them to go back in and delete their answers, and no way for the researcher to determine which survey was filled out by them.

Signatures

Your signature below indicates that you have had your questions about the study answered to your satisfaction and have received a copy of this consent form for your own records.

Your signature indicates that you consent to participate in this study and that your responses may be put in anonymous form and kept for further use after the completion of this study.

(On parental consent forms include a statement of choice; for example: "I consent/I do not consent (circle one) to my child's participation in this study."  Please note that parents must be provided with a copy of the parental consent form.)

___________________________________________            _______________________
Research Participant Signature                                                       Date
(or Parent or Guardian Signature)

_____________________________________________________________
Printed Name of the Research Participant (or Parent or Guardian) signing above

Note:  If you are using an online survey, instead of the statements above regarding their signature use the following statement.

By clicking "continue" you are indicating that you consent to participate in this study and that your responses may be put in anonymous form and kept for further use after the completion of this study.  You may print a copy of this consent form for your own records.