University of Michigan

     National Center for Postsecondary Improvement

        Project 5.3 on Student Learning and Assessment

A Sample Administrative Consent Form

  An Administrative Consent Form is normally used when the researcher needs to video/audio-tape the interview or other activities. 

   Administrative Consent Form

Audio Tape Release Form

I voluntarily agree to be audio taped during the interview being conducted by the [Name and the Organization of the Principle Investigator]. I understand that the tapes will be used to gather information about faculty's academic life, and such information will be used to generate a [possible kinds of work produced out of this project]. The tape will be kept for approximately one year and will be securely stored at [Name of the Organization of the PI]. After the data is collected and transcriptions are made, the tapes will be destroyed.

__________________________                    _____________________

My Signature                                                         Date

__________________________                    _____________________

Signature of the Investigator                                    Date

Refusal to be Taped

I do not agree to be audio taped during the interview conducted by [Name of PI and his/her Organization]. I understand that I will not receive compensation. By refusing to be audio taped, I understand that I may not continue to participate in the study.

__________________________                    _____________________

My Signature                                                         Date

__________________________                    _____________________

Signature of the Investigator                                    Date

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