CONSENT FORM

Thesis Topic:
Researcher:
This research intends to examine the _________.
By signing this consent form, you voluntarily agree to participate in this study as a discussant, as
well as allow the recording of the discussion and taking of notes by the facilitator. You also allow
for the results to be publicized and to be quoted by the researcher in any part of the study.
Finally, you understand that you may choose to withdraw your participation from the study and
to disallow the release of any information gained during the interview by directly contacting the
researcher. All information provided by the interviewee will solely be used for the purpose of the
study.
For queries, please do not hesitate to contact ____ via _____.
Thank you very much.
______________________
Signature over Printed Name
_______________________
Date
_______________________
Year and Course
_______________________
Class Section