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CONSENT TO PARTICIPATE IN RESEARCH

Title of the Project: Life History of ___________________________

Name of the Student: _________________________________

Subject and Time: _________________________________
Year and Course: _________________________________
E-mail address: _________________________________

Faculty-in-charge: Roland A. Dalagan

Asst. Prof. III
Institute of Business and Public Affairs (IBPA)
Davao Oriental State College of Science and Technology
Mati, Davao Oriental
roland.dalagan@gmail.com
09298070030

You are invited to participate in a research study conduct by the above-

mentioned name of student-researcher at DOSCST, Mati, Davao Oriental. You
must be at least 18 years of age to take part of this research study. Your
participation is voluntary. You should read the information below, and ask
questions about anything you do not understand, before declining whether or not
to participate. Please take time as you need to read the consent form. You may
also decide to discuss it with your family or friends. If you decide to participate,
you will be asked to sign this form. You will be given a copy of this form.

1. Purpose of the Study: The purpose of this research is

_____________________________________. This research is also aimed to know
_________________________________________________________________________.

2. Procedures to be followed: If you volunteer to participate in this study, you will

be asked to:
2.1. You will not be asked to talk about any of your own or other’s private
experiences that you would consider too personal or revealing.
2.2. During the in-depth interview, the audio recorded, and some
photographs will be taken. The audio recording and the picture taking will
be used in documentation.
2.3. The information which will give through the oral interview will be put into
written form of the interview will be asked to be feedback to you and asked
to be signed as a documentation of your approval of what is written is what
you verbally told.
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3. Duration/Time and Location of the Study to be conducted:

3.1. The duration of the actual interview will be _______ minutes.
3.2. If during the processing of the data you gave, there are some gaps or
missing information, you will ask for one (1) additional/follow up interview
session of not more than 45 minutes.
3.3. The interview will be conducted in a place nearest to you place, upon
your choosing and ensuring safety to you and to the researcher.

4. Statement of Confidentiality:
Your participant in this research is confidential. Only members of the
research team will have access to the associated with this study. The data will be
stored and secured at the investigator’s office in a locked cabinet/password
protected computer.
Any information that is in connection with this study and that is identified
with you will remain confidential and will be disclosed only with your permission or
a required by law. When the result of the research is published or discussed in
conferences, no information will be conducted that would reveal your identity.

5. Rights of Research Participants to Ask Questions:

If you have any questions snout your rights as a study subject or you would
like to speak with someone independent of the research team to have questions
answered about the research, or is the event the research staff cannot be
researched, please contact, ________________.

6. Payment/Compensation for Participant:

In acknowledgement that the participants might have taken time away
from your work, livelihood and other obligations thereby you lose some of your
daily wage income, you will be given reimbursement by the researcher.

7. Participant and Withdrawal:

Your decision to be in this research is voluntary. You can stop at any time.
You do not have to answer any questions you do not answer. Refusal to take part
in or withdrawing from this study will involve no penalty or loss of benefits you
would receive otherwise. You are not waiving any legal claims, rights or remedies
because of your participation in this research study.
If you are so traumatized recalling your experience about Alsa Masa that
continuing you as a participant of this research of this research will greatly harm
you. The investigator may withdraw you from this research if circumstances arise
which warrant doing so.
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If you agree to take part in this research study and the information outlined
above, please sign your name and indicate the date below.

A copy from this form will be given to you for your records.

SIGNATURE OF RESEARCH PARTICIPANT

I have read (or someone has read to me) the information provided above.
I have been given a chance to ask questions. My questions have been answered
to my satisfaction, and I agree to participate in this study. I have been given copy
of this form.

_____________________________
Name of the participant Thumb mark if participant cannot write

_____________________________ ______________________
Signature of the Participant Date

(If the participant, register his/her consent by thumb mark, there will be a witness, who
will also sign as a witness. The student-researcher cannot serve as a witness)

CONSENT TO BE TAPE-RECORDED/HAND WRITTEN NOTES

Please put a check on the box provided before the statement

( ) I am willing to have this interview tape-recorded

( ) I am willing to have the interview recorded in handwritten notes

_________________________ ___________________
Name and Signature Date

CONSENT TO BE TAKEN PHOTO SHOTS:

Please put a check on the box provided before the statement

( ) I am willing to have this interview documented through photo shots

( ) I am willing to have the interview documented but photo shots are silhouette
or the back portion only

_________________________ ___________________
Name and Signature Date
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SIGNATURE OF THE STUDENT-RESEARCHER

I have explained the research to the subject and answered all his/her
questions. I believe that he/she understands the information described in the
document and freely consents to participate.

______________________________________________ __________________
Name Signature of the Student-researcher Date