Consent form for Interview

TITLE: Case study for Leadership in Inclusive Education

Purpose
The purpose of this interview is to gather data to that will help to gain a better
understanding of leadership in inclusive education in schools in the Cayo District of Belize. The
interview will ask demographic data as well your perception and experiences of being a principal
in a primary school in Cayo District of Belize. The interview should not last longer than 30
minutes.

Terms and Conditions of Interview

By signing the consent form I am agreeing to the following terms:

 I understand that I am voluntarily participating in the study

 I have had the purpose and nature of the study explained to me and I have had a chance to
ask questions about the study.
 I understand and agree to the interview being conducted on zoom and being recorded.
 I understand that I will not benefit from participating in this research.
 I understand that the information collected will be treated confidentially
 I understand that my identity will remain anonymous as my name will be changed and
distinguishing details which may reveal my identity or the identity of people I speak
about will be changed.
 I can withdraw at any point during the interview without any consequences of any kind.
 I have the right to refuse to sign this consent form without any repercussion on my
current and future care.
 I may seek additional information, or ask questions regarding the research following the
interview by contacting the interviewer at 601-4947 or elisharee@yahoo.com

___________________________ _______________________
Signature of Interviewee Date
Declaration of the person responsible to obtain the consent

I, Sharee Gutierrez, certify that I have explained this form to the participant and answered any and all
questions that she/he asked on the matter and have clearly identified that she/he can revoke their consent
and withdraw, at any time, their participation to this study as described above. Thus, I will ensure that the
objectives of this study will be pursued and the confidentiality respected.

___________________________ _______________________
Signature of observer Date