Data Privacy Consent Form

NORTHEASTERN COLLEGE
College of Nursing
Santiago City

Dear Respondents,

Greetings!

We would like to borrow ten (10) minutes of your time to answer our survey
questionnaire for our research study entitled “title of your research" This study aims to
___________________.

The researchers will be using self-constructed questions in determining the

_________________________.

Please be assured that all personal data will be treated CONFIDENTIALLY and the
answers you provide in this survey will be collected for the sole purpose of the research study.
For any clarifications and concerns, please contact us at any of the following emails:

Name of the Researcher email

Name of the Researcher . email
Name of the Researcher email
Name of the Researcher email
Name of the Researcher email

The researchers observe and implement the DATA PRIVACY CLAUSE (Republic Act
10173 - Data Privacy Act of 2012).

By submitting the survey form, you consent to the collection, generation, use,
processing, storage and retention of your data by the researchers which will be solely used for
research study and the information that you provide is true and correct.

Truly yours,

The Researchers