Fillable Printable Interview Consent Form - UTAS

Interview Consent Form - UTAS

Interview Consent Form

Name of unit ________________________________________________

Name of assignment__________________________________________

School of English, Journalism and European Languages

1. I agree to be interviewed for the purposes of the student assignment named above.

2. The purpose and nature of the interview has been explained to me, and I have read

the assignment and/or information sheet as provided by the student.

3. I agree that the interview may be electronically recorded.

4. Any questions that I asked about the purpose and nature of the interview and

assignment have been answered to my satisfaction.

5. Choose a), b) or c):

a) I agree that my name may be used for the purposes of the assignment only and not

for publication.

b) I understand that the student may wish to pursue publication at a later date and my

name may be used.

c) I do not wish my name to be used or cited, or my identity otherwise disclosed, in

the assignment.

Name of interviewee_______________________________________

Signature of interviewee____________________________________

Date______________________

6. I have explained the project and the implications of being interviewed to the

interviewee and I believe that the consent is informed and that he/she understands the

implications of participation.

Name of interviewer________________________________________

Signature of interviewer_____________________________________

Date_____________________