CCSG

Appendix E (Sample of Oral Consent Form Used for a Survey in Tunisia)

Sample of Oral Consent Form Used for a Survey in Tunisia

Hello. I am from [SURVEY DATA COLLECTION COMPANY NAME] and am working in collaboration with [UNIVERSITY IN TUNISIA]. We are carrying out academic research in Tunisia on what people value in life. This research will interview a nationally representative sample of the population in Tunisia. Your home address has been selected randomly as part of a representative sample of the people living in Tunisia.We are seeking your permission to ask your opinion on topics such as development, beliefs about families, politics, media use, corruption, and various other attributes of individual and family life. For example, we might ask you how optimistic you feel these days, or about how important you think democracy is when discussing attributes of a good government. Please be assured that there is no right or wrong answer to any of these questions. Your help is extremely important because it will contribute to a better understanding of what people around the world believe and want out of life.

Your answers will be kept completely confidential. Your identifying information will be kept in a separate, secure location from your survey responses and will be linked only by an arbitrary identification number. We believe there is no risk to you for taking part in this study. Any answers you give will be combined with the responses of all other participants. This means that no one will be able to trace the identities of any of our individual participants. The results of this research will be used for academic purposes only and will be disseminated in scholarly journals and presentations. This research may be indirectly beneficial to you because it contributes to the development of the social sciences and to public policy. However, you will experience no direct benefits from participating in this study. This interview will take about an hour or so and I want to assure you that it is completely voluntary and confidential. If we should come to any question that you do not want to answer, please let me know and we will go on to the next question. There is no penalty for not participating or for refusing to answer any question. You may stop the interview at any time. We may contact you in the future about an opportunity to participate in a follow-up discussion about some of the same topics raised in the questions I’ll be asking you today. Again, participation in any subsequent interview would be completely voluntary and confidential. This research protocol and informed consent document has been reviewed and approved by Eastern Michigan University Human Subjects Review Committee for use from _________ to _________ (date). If you have questions about the approval process, please contact (PRINCIPAL INVESTIGATOR NAME) (PHONE, EMAIL) or the Eastern Michigan University Human Subjects Review Committee (PHONE). By verbally stating “I agree,” you are indicating that you are at least 18 years of age, you have had this consent form read to you, your questions have been answered, and you voluntarily agree to participate. If you agree, please state “I agree.” If you want to know more about the study, you can call (NAME) or (NAME) [SURVEY DATA COLLECTION COMPANY NAME] at (PHONE). Sample of Written Consent Form Used for a Survey in Tunisia Hello. I am from [SURVEY DATA COLLECTION COMPANY NAME] and am working in collaboration with [UNIVERSITY IN TUNISIA]. We are carrying out academic research in Tunisia on what people value in life. This research will interview a nationally representative sample of the population in Tunisia. Your home address has been selected randomly as part of a representative sample of the people living in Tunisia. We are seeking your permission to ask your opinion on topics such as development, beliefs about families, politics, media use, corruption, and various other attributes of individual and family life. For example, we might ask you how optimistic you feel these days, or about how important you think democracy is when discussing attributes of a good government. Please be assured that there is no right or wrong answer to any of these questions. Your help is extremely important because it will contribute to a better understanding of what people around the world believe and want out of life. Your answers will be kept completely confidential. Your identifying information will be kept in a separate, secure location from your survey responses and will be linked only by an arbitrary identification number. We believe there is no risk to you for taking part in this study. Any answers you give will be combined with the responses of all other participants. This means that no one will be able to trace the identities of any of our individual participants. The results of this research will be used for academic purposes only and will be disseminated in scholarly journals and presentations. This research may be indirectly beneficial to you because it contributes to the development of the social sciences and to public policy. However, you will experience no direct benefits from participating in this study. This interview will take about an hour or so and I want to assure you that it is completely voluntary and confidential. If we should come to any question that you do not want to answer, please let me know and we will go on to the next question. There is no penalty for not participating or for refusing to answer any question. You may stop the interview at any time. We may contact you in the future about an opportunity to participate in a follow-up discussion about some of the same topics raised in the questions I’ll be asking you today. Again, participation in any subsequent interview would be completely voluntary and confidential. This research protocol and informed consent document has been reviewed and approved by Eastern Michigan University Human Subjects Review Committee for use from _________ to _________ (date). If you have questions about the approval process, please contact (PRINCIPAL INVESTIGATOR NAME) (PHONE, EMAIL) or the Eastern Michigan University Human Subjects Review Committee (PHONE). If you want to know more about the study, you can call (NAME) or (NAME) of [SURVEY DATA COLLECTION COMPANY NAME] at (PHONE).

Consent

The nature and purpose of this research have been sufficiently explained and I give my consent to participate in the interview. Name (PLEASE PRINT CLEARLY): _____________________________________________

Signature: _______________________________________Date: ______________________