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This sample is a template from which a verbal consent script can be developed. The language does not have to be repeated verbatim. THE CONSENT SCRIPT SHOULD BE WRITTEN IN TERMS UNDERSTANDABLE TO THE SUBJECT (avoid or define technical terminology, adjust for educational background and ages, provide translations in other languages when subjects do not understand English). Information provided in italics needs to be filled in and the italics deleted.

This is [ name of investigator ], from the University of Oregon [ department affiliation and status, professor or if student, indicate that results will be used in thesis/dissertation ]. Thank you for agreeing to participate in my research project. The research will help me understand [ state benefits to subjects and humanity expected from research ].

Today you will be participating in [ individual phone interview, group phone interview, etc. ], which should take approximately [ state time needed to complete activity ]. Your participation is voluntary. If you do not wish to participate, you may stop at any time. Responses will be [ describe confidentiality procedures – e.g. responses will be completely anonymous; your name will not appear anywhere in the final write up; I will assign you a pseudonym, etc. ]. Taking part in this interview is your agreement to participate.

[ If this is a group interview, the following language needs to be included: “During the group interview, I will not be able to guarantee confidentiality because we will be discussing information as a group. Therefore, if you would feel uncomfortable with any of your statements being shared with others in or outside the group, please do not share them during the process. ]

If you would like a copy of this information for your records, please let me know and I will [ give you a copy now; email, mail, or fax it to you, etc. ]. If you have any questions regarding the research, contact [ give name, department, phone number, and department address if applicable. Include advisor name/phone if student, and identify as advisor ]. If you have any questions regarding your rights as a research subject, please contact the Office for Protection of Human Subjects at the University of Oregon , (541) 346-2510 . Thank you again for your help.

Do you agree to participate in this interview?

If applicable include the following statement : Do you agree to be audio/video recorded?