ESSEC Business School

Consent Form for Participation in a Research Study

Title of Study

DESCRIPTION: You are invited to participate in a research study on (describe project in non-technical language; include types of questions that will be asked, if applicable; explain purpose of the research). You will be asked to (describe procedures; mention video/audio taping, if applicable, and what will become of tapes after use, e.g., shown at scientific meetings; describe the final disposition of the tapes).

TIME INVOLVEMENT: Your participation will take approximately (insert duration).

PROTECTION OF CONFIDENTIALITY: The information that you give in the study will be handled confidentially. Your information will be assigned a code number. The list connecting your name to this code will be kept in a locked file. When the study is completed and the data have been analyzed, this list will be destroyed. Your name will not be used in any report.

Or

The information that you give in the study will be handled confidentially. Your data will be anonymous which means that your name will not be collected or linked to the data.

PAYMENTS: You will receive (describe reimbursement; where there is none, state as such) as payment for your participation.

PARTICIPANT’S RIGHTS: If you have read this form and have decided to participate in this project, please understand your participation is voluntary and you have the right to withdraw your consent or discontinue participation at any time . In this case, you will not earn any money (or credits). You have the right to refuse to answer particular questions. The results of this research study may be presented at scientific or professional meetings or published in scientific journals.

Or

If you have read this form and have decided to participate in this project, please understand your participation is voluntary and you have the right to withdraw your consent or discontinue participation at any time without penalty or loss of benefits to which you are otherwise entitled. You have the right to refuse to answer particular questions. The results of this research study may be presented at scientific or professional meetings or published in scientific journals.

DEBRIEFING: A debriefing will be done at the end of the study.

CONTACT INFORMATION:

If you have any questions, concerns or complaints about this research, its procedures, risks and benefits, contact the Researcher, (name and email of Researcher).

AGREEMENT:

I agree to participate in the research study described above.

Signature: ________________________________________ Date: _____________