The informed consent form or statement should be written in clear and plain language, and will normally include the following presented on institutional/departmental letterhead:

Title of the Research Study:

Researcher Identity:
Provide the names and contact information of all researchers.

• names (student, faculty)
• student status (if applicable)
• organization
• email address(es)
• contact phone number(s)

Purpose and Use of the Research:

• Indicate whether the research is for the purposes of a graduate degree, an institutionally funded project, etc.
• State the purpose of the research or what the study is designed to assess or establish in language appropriate to the comprehension/reading level of the participant population (e.g., improvement of program, more effective intervention strategies, or creation of effective protocol).
• Also include a statement outlining any potential publication or commercialization of the research findings (e.g., submission as a publication, thesis, report, videos, etc.)
• Ensure the description of the purpose provided in the consent document is consistent with the purpose described in the application.

Voluntary Participation:
Include a statement making it clear that although the research application has been reviewed and approved by the External Research Review Committee of the York Region District School Board and the schools' principal, participation in the research is voluntary. Participants do not have to answer questions that they do not want to, and may discontinue participation in the research at any time without penalty.

What You Will Be Asked to Do in the Research (Procedure):
Include a statement about the nature and duration of the participant's involvement.

• Describe the research procedures that the participant will be involved in.
• State the expected amount of time for the participant's involvement.
• In order to guarantee that consent is fully informed include topics and samples of questions similar to those to be used in the study.
• Where relevant, provide information about audio or videotaping.

Withdrawal from the Study:
Include a statement that participants may discontinue participation in the research at any time without penalty. In the event a participant withdraws from the study, state that all associated data collected will not be included in the results and immediately destroyed.

Potential Risks and Discomforts:
Include a clear statement of any risks, harm, or inconveniences to participants, including minimal risks.

• How much instructional time will be missed by students if required to participate in the study.
• If there is a possibility of harm, it needs to be described and mitigation methods need to be indicated.
• Include a statement of any potential conflicts of interest the researchers might have.

Potential Benefits:
Describe benefits realized as a result of the research.

• Include benefits to the participant and/or possible benefits to society, education or science.
• Monetary compensation is not a benefit and is not permitted.
• If the participant will not benefit from participation, clearly state this fact.

Confidentiality and Anonymity:
Describe procedures to ensure confidentiality of data and anonymity of participants.

• Include information on the extent to which, and the manner in which, records identifying the participant will be kept confidential.
• Provide information on length of retention and security of data and who will have access to the data.
• If the information will be released to any other party for any reason, state the person/agency to whom the information will be given, the nature of the information, and the purpose of the disclosure.
• Include a statement indicating that the researchers intend to publish the research (for example, in scholarly publications), or that the researchers intend to make public presentations based on the research. If the results of the study are published, indicate that the participant's identity will remain confidential.
• In those rare instances where it will not be possible to assure complete confidentiality, the limits on this obligation should be carefully explained (for example, participation in focus groups).
• In consent forms for focus groups, the researcher should consider adding a statement about the potential harm that could exist if confidentiality is violated by another participant of the focus group.
• If activities are to be audio or videotaped, describe the participant's right to review/edit the tapes or transcripts, who will have access, if they will be used for educational purposes, and when they will be erased.

Authorization:
Include a statement that indicates participants are fully informed and freely give their consent to participate in the research.

• Include a statement that the participant has received a copy of the consent form for their records.
• Include a statement informing the participant that the project has been approved by the Research Ethics Board.

Contact Information:
Include researcher contact information for participants who have questions or concerns.

• Name(s)
• Organization
• Phone number
• Email address

Signature(s):
Include a section for the participant’s signature.

• State that the signature indicates authorization to participate in the study.
• Include the name and signature of the parent/guardian for students under the age of 18.

Extend Appreciation to Participants & Return of Consent Form:

• Thank participants.
• Include instructions for the return of the form.
• Describe how participants will be informed of the results of the research (if applicable).