Research Study Sensitive Data Consent Form

Study Title:

Researcher(s) Name(s):

Institution/Organization:

Purpose of the Study

Types of Sensitive Data Collected

How Your Data Will Be Used

Confidentiality

Your Rights

• You may withdraw at any time.

Contact Information

Consent

I have read and understood the information above, and I consent to participate in this research study and for my sensitive data to be collected and used as described.