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Adobe Scan Oct 16, 2023

The document describes an informed consent form for participation in a research study. It outlines that the participant agrees to volunteer for the study, understands the study description and their role, understands they can skip questions or withdraw consent, and that their data will remain confidential and anonymous. It also confirms the participant does not have any physical or mental illnesses that would impact participation risk.

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Lovis Kumar
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22 views

Adobe Scan Oct 16, 2023

The document describes an informed consent form for participation in a research study. It outlines that the participant agrees to volunteer for the study, understands the study description and their role, understands they can skip questions or withdraw consent, and that their data will remain confidential and anonymous. It also confirms the participant does not have any physical or mental illnesses that would impact participation risk.

Uploaded by

Lovis Kumar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Nan,c: ... .. . . . . . .. . . . . . . . . .... . .. .. . . .. . . . . . . . . . . . . . .. .. . . ... . . . .. . . . .. . . . . .........

(Optional)

.Gen<.ler:. ..... ... .. ......................... •


Educational Qualilica1ion:............. .. ... . .... ...... .. .... .. ............... ..... ••••.. ······..

Informed Consent
This is to certify that, 1 ........!, .. .'................................. .. ....................·..... , hereby agree to participate •as a
volunteer in an investigation (experiment, program, practical) as an authorized part of the academic
activity under the supervision of ........:... ........................_. .............................................................................. .
7
The investigation and my part in the investigation have been defined and fully explained to me by
···············:········.. ····• ....._. ..........................................._. ... ,and I understand his/her explanation.
I have been given the opportunity to ask whatever questions I may have had and all such questions
and inquiries have been answered to my satisfactions. ·

I understand that that I am free to deny any answers to specific items or questions in interview or
questionnaire.

I understand that the data and answers to the questions wlll be kept confidential with regards to my
identity. I also understand that the data and answers are only for academic purposes. I understand
that by participating in the investigation there will not be any effects on my physical, social, cultural,
spiritual, psychological, and religious and belief system.

I also understand that I will not receive any remuneration 'for my participation in the investigation.

I certify that to the best of my knowledge and belief, I have no physical and mental Illness or weakness
that would increase the risk of my participation of this Investigation.

I further understand that I am free to withdraw my consent and terminate my participation any time.

Date: Signature bf the Participant


: ,.
Place: Name of the Participant

'1' ' 1
Date: Signature of the Investigator
I •
Pia~ Name of th~ Investigator
11

1ntuction~
'
t. You must select one of the two statements.
!2. Both the options are equally correct.
3. Please choose fih:e respo~se that you ~ould most likely ~se, even though neither the
"A" nor the 11 9!t ·statemcm is very typical of your behavior.
4. The test has no set time-limit.
I

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