Sample Consent Forms
Individual Interviews
What Is This Study About?
You are invited to participate in a research study entitled _____________________________.
The purpose of the study is to identify gaps and barriers in services available to crime victims
with disabilities in our community. You are being asked to participate because (a) you are a
person with a disability, (b) you are a disability service provider, (c) you are a victim service
provider, (d) you work in law enforcement, or (e) other
_________________________________________.
The study is being conducted by ________________________________________________
__________________________________________________________________________
(name of project coordinator, agency name, address, phone number).
What Will I Be Asked To Do?
You will be asked to answer questions about services for crime victims with disabilities in our
community, either from your personal or professional experience. Someone from our staff will
take notes, but we will not attach your name to the notes. We estimate that it will take about 1
hour for you to answer the questions. You will only need to participate in one interview.
If you request, a professional, certified American Sign Language or Spanish interpreter will be
used in this study. As a professional, this interpreter is required to keep confidential your name