Informed Consent

Psychological Interview

PURPOSE
You are asked to participate in an interview. The purpose of this interview is to let the students of the
Psych 163 class apply what they have learned about Psychological Interviewing. This interview will
only be conducted by those who voluntarily indicated their intention to participate. 

RISK AND BENEFITS

Participation includes a one–time voluntary participation. A token of appreciation will be provided
after the interview. There are no substantial risks or disadvantages expected to arise in the interview,
and the client may discontinue anytime they feel uncomfortable. 

CONFIDENTIALITY
The name of the participant will not be exposed. Any data obtained from the interview will be used
solely for the course requirement. 

INTERVIEWER

CONTACT INFORMATION
__________________________________________________________________________________

INTERVIEW PARTICIPATION AGREEMENT

I have read the consent form, understand the provided information, and have had the opportunity to
ask questions. The undersigned had explained the instructions in detail and answered my questions
adequately. I express my voluntary participation in this interview, and I acknowledge that I may
refuse to participate at any time, and there will be no ill consequences for me.
I acknowledge receipt of this informed consent. I know the name and contact information of the
interviewer I can contact for questions relating to the ethical aspects and conduct of this interview.

Interviewer: Signature: Date:

Interviewee: Signature: _______________ Date:________