CONSENT FORM

You are being invited to participate in a research study that seeks to ________________________________________.

This study is being conducted by ______________________ who is currently completing their output/project for the
course MATH 1 – Mathematics in the Modern World at the Quezon City Polytechnic University, San Bartolome Novaliches,
Quezon City.

I, ___________________________________ being over the age of 18 years old (legally independent) hereby consent to
participate/ be a respondent in this research study titled
“________________________________________________”.

 I am aware that I should keep a copy of the Consent Form for future reference;

 I understand that:
(1) I may not directly benefit from taking part in this research.
(2) I am free to withdraw from the participation in this research at any time and I am free to refuse to
answer particular questions.
(3) While the information gained in this study will be published as explained, I will not be identified, and
individual information will remain confidential.
(4) I may ask the audio recording be stopped at any time, and that I may withdraw at any time from the
interview without disadvantage.

Participant’s signature: Date:

E-mail address:

I certify that I have explained the purpose of research to the participant and consider that she/he understands
what is involved and liberally consents to participate.

Researcher/s

Date