Informed Consent Sample

Date:   

To:       
From:    instructor , e-mail, extension
Re:       Your permission to be interviewed

We appreciate your willingness to help our Composition II students learn more about the uses of writing at JCCC beyond what occurs in the Composition classroom.  As we stated in our March 22 e-mail (posted on sennet), our purpose with this research is for our students and ourselves to learn more about how and why instructors from all disciplines use writing in their courses.  This interview should last no longer than 30 minutes.

This memo constitutes your informed consent to be interviewed by a team of students.  Please read what follows and sign both copies, keeping one for yourself.

The students have worked with us to design questions to ask you.  If you requested, we provided you questions in advance.  Students will take notes and possibly ask your permission to tape the conversation for greater accuracy.  You have the right to grant permission or decline that request.

The students have been informed of the ethics of qualitative research of this sort.  Please sign below if you would like them to use a pseudonym when they work with your information.  You also may request to receive the write up of the interview to confirm that your thoughts are accurately represented.  When the project ends, the instructors will assume responsibility for the field notes and related materials.   

The students will use this information to write individual or group papers for class.  They may give panel presentations to students in the class sections that are engaged in this project and possibly to others as well. If the instructors report on this project in a professional forum (conference or journal), requests to use pseudonyms will continue to be respected.

The design for this research project has cleared Institutional Research.  If you have questions concerning any aspect of the research, please contact either instructor at the e-mail or phone extensions listed above.  Our offices are in ___.

                                                                                                                                               

I give my permission to be interviewed for Composition II’s Writing Across JCCC research project:___________________________________________Date_____________________

___I would like to use a pseudonym.  The name (first and last, please) I’ve selected is________
___I would like to read the write-up of the interview.

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