Culturally Sensitive Consent Form
For Indigenous Community Surveys
Project Information
Project Title
Researcher/Organization Name
Contact Email or Phone
Purpose of the Survey
How Your Information Will Be Used
Voluntary Participation
Confidentiality & Cultural Sensitivity
Right to Withdraw
Additional Considerations
Contact for Questions
Consent Statement
I have read or have had read to me the above information and agree to participate in this survey.
Name of Participant
Date
Name of Witness (if needed)