Manuel S.

EnvergaUniversityFoundation
LucenaCity,Philippines

Granted Autonomous Status

CHED CEBRes.076-2009

INFORMED CONSENT

In signing this document I am giving my consent to be interviewed by the researchers from

Manuel S. Enverga University Foundation, Lucena City. I understand that I will be part of a
research study that will focus on A Design of Underwater Flow-Powered AC Generator in Brgy.
Gagalot Majayjay Laguna. This project study is focused on the following objectives: (1) to
design an underwater flow-powered AC generator (2) to design a circuit of the designed
underwater flow-powered AC generator (3) to fabricate a prototype of the designed circuit (4) to
evaluate the prototype in terms of functionality and effectiveness.

I understand that I will be interviewed in my home at a time convenient to me I will be asked

some questions relative to the lack of electricity in our barangay, the importance of
constructing an alternative source of electricity and the evaluation of the designed project.

This interview was granted freely. I have been informed that the interview is entirely voluntary,
and that even after the interview begins I can refuse to answer any specific questions or decide to
terminate the interview at any point. I have been told that my answers to all questions will not
give to anyone else and no reports of this study will ever identify me in any way. I also been
informed that my participation or non-participation or refusal to answer question will have no
effect on services that I or any of my member of my family, may receive from health services
providers.

I understand that I will be informed of the results of this research if I ask for them and that Mr.
Roberto B. Abulencia Jr., Mr. Emmanuel Jusua S. Del Rio, Mr. Lemuel C. Parco, Ms.
Sharmaine G. Cortas are the persons to contact if I have any questions about the study or about
my right as a study participant. I was informed that they can be reached through this number
09506341548.

Date:________________ ________________________
Respondents Signature

MR. ROBERTO B. ABULENCIA JR. MR. EMMANUEL JUSUA S. DEL RIO

Interviewers Signature
Interviewers Signature

MR. LEMUEL C. PARCO MS. SHARMAINE G.

CORTAS

COLLEGEOF
ENGINEERING&TECHNICALDEPARTMENT
Manuel S.Enverga University
 Manuel S.EnvergaUniversityFoundation
LucenaCity,Philippines

Granted Autonomous Status

CHED CEBRes.076-2009
Interviewers Signature Interviewers
Signature

COLLEGEOF
ENGINEERING&TECHNICALDEPARTMENT
Manuel S.Enverga University