Title: Consent Form for Participation in the Usability Evaluation
Author: Daniel Woo
Company: Human Computer Interaction, CSE, UNSW

Consent form for participation in [description of session, eg.web site usability test]
DELETE THIS PARAGRAPH FROM YOUR FINAL CONSENT FORM. STUDENTS YOU MUST FILL IN OR DELETE AREAS MARKED IN YELLOW OR ARE SURROUNDED BY <DELETE> </DELETE> TAGS. THIS IS PROVIDED AS A TEMPLATE SO YOU CAN SEE AN EXAMPLE OF A CONSENT FORM USED IN COMMERCIAL USABILITY TESTING. DO NOT USE THIS SHEET WITHOUT CAREFULLY READ IT AND MAKING THE APPRORIATE CHANGES. 
Please read the following information carefully.
[Student/Researcher] is conducting today’s research on behalf of The University of New South Wales. The research is being used as a class assessment exercise for a course Human Computer Interaction at The University of New South Wales. The topic is concerned with the design of an interactive museum exhibit.
As a participant in the session, we will ask you to help us understand how you work and your wants and needs for [application or site description].  The observations and information we collect today will help us to build improvements into the designs and will be used as part of our University assignment work that help us learn about involving users in the design process. If you have any questions, we encourage you to ask them. 
As your participation is entirely voluntary, you may choose to withdraw from the session at any time.

If you have any further queries you can contact [Student/Researcher] on [Contact telephone number] or [e-mail address]. 
Your privacy, observers & recording of data
Please be assured that the information and opinions you provide today will be used only for research purposes. 
<DELETE>Representatives from the companies involved in the research will be observing the session [from behind the one-way mirror/via CCTV]</DELETE>.
We will record information about how you might use and interact with the site (including <DELETE>on videotape, audiotape and </DELETE> questionnaire). This will help us see how to make the design more useful and easier to use. For any and all uses of this recorded data, we undertake to guarantee your anonymity. Your name will appear only on this form, which will be filed separately, and is kept only to verify your consent to participation in this session. The form will be destroyed within 2 months of this session.
The data recorded may be used for:
•	Analysis, to review interactions after the session
•	Documenting the findings of the session
•	Providing feedback to the project team about the design and how well it does/does not meet peoples’ needs or communicating the same to other stakeholders within the organisation sponsoring the research
•	Teaching or training purposes by [researcher] or [client] but only for demonstrating the process of a typical research session (eg. how to run this type of session).
<DELETE>Representatives from the companies involved in the research may be present during the session. You can be assured that if any one of them recognises anyone here they will cease to observe the session.
•	We may wish to pass the tape(s) on to [client] to be used for their research purposes. If you sign this sheet you give your permission to be taped and for the tape(s) to be passed on to the organisation sponsoring this research, with the understanding that if anyone of them recognises you, they will cease watching or listening to the tape.
The tapes will not be transferred to anyone else unless your consent has been obtained. </DELETE>
Please continue over…

<DELETE>Non-disclosure
By participating in this session, you may be privy to information that [client] regards as confidential, and must accept that [client] is the sole and exclusive owner of this confidential information.
You must not at any time after the session disclose to any other person or use, adopt, be a party to, aid or abet any disclosure, use, adoption or employment of this confidential information either directly or indirectly for any purpose. </DELETE>
If you have read the above information carefully and understand and consent to its contents, please complete and sign the following statement.

I, | |
| (Participant’s Name – please print) |
have read the above passage carefully and understand its contents. I voluntarily agree to participate in the site evaluation conducted by [researcher].
<DELETE>I acknowledge receipt of $	 to compensate for out-of-pocket expenses and state that my participation is of a totally private and/or domestic nature.</DELETE>

(Participant’s Initials/Signature) | | (Date)
(Researcher’s Signature) | | (Date)