Example of Consent Form (for an interview)

This fits on one page. The second page includes a description of the project, the interview questions, and the researcher’s contact information. The interviewee keeps that.

Thank you for contributing to this project on [general description]. [Your name] will have your responses transcribed and translated. I will send you the transcription for your review and comment. In addition, I will send you a copy of any text based on this interview that she shares publicly and would welcome your comments on that as well.What is the best way of communicating this information with you?


Would you like me to refer to your insights and words
1) anonymously only, as


(example: “a health expert in Bangladesh, specializing in AIDS” or “an expatriot development worker in Zimbabwe” or “a student and activist”)

2) by name, as


(example: Brooke Ackerly, Vanderbilt University, Nashville, TN, USA)

I agree to be interviewed and to have my words and insights used by [your name] according to my preferences indicated above.