Sample Informed Consent Letter For Case Study

Institutional Review Board

Sample Form: Consent Cover Letter for Survey Research



NOTE:  Fill in blanks “italicized language” (add/delete) as appropriate to your research.  Remember to delete these instructions and any other non-applicable language.

Dear Participant,

I invite you to participate in a research study entitled (specify): _______________________. I am currently enrolled in the (specify program) at Notre Dame de Namur University in Belmont, CA, and am in the process of writing my (i.e., Master’s Thesis). The purpose of the research is to determine: ________________________________________________.

The enclosed questionnaire has been designed to collect information on:  _________________________________________________.

Your participation in this research project is completely voluntary. You may decline altogether, or leave blank any questions you don’t wish to answer. There are no known risks to participation beyond those encountered in everyday life. Your responses will remain confidential and anonymous. Data from this research will be kept under lock and key and reported only as a collective combined total. No one other than the researchers will know your individual answers to this questionnaire.

If you agree to participate in this project, please answer the questions on the questionnaire as best you can. It should take approximately (specify time)to complete. Please return the questionnaire as soon as possible in the enclosed business reply envelope.(OR give instructions as to what to do with the completed survey)

If you have any questions about this project, feel free to contact INVESTIGATOR name & title at CONTACT INFORMATION. Information on the rights of human subjects in research is available through the NDNU’s Institutional Review Board at Notre Dame de Namur University 1500 Ralston Avenue, Belmont, CA, 94002; website:; (insert name and contact number of the current IRB Chair).

Thank you for your assistance in this important endeavor.

Sincerely yours,



Informed Consent Form Templates

(language used throughout form should be at the level of a local student of class 6th/8th)

Notes to Researchers:
  • Please note that these are templates developed by the WHO ERC to assist the Principal Investigator in the design of their informed consent forms (ICF). It is important that Principal Investigators adapt their own ICFs to the outline and requirements of their particular study. The logo of the Institution must be used on the ICF and not the WHO logo.
  • The informed consent form consists of two parts: the information sheet and the consent certificate.
  • Do not be concerned by the length of these templates. They are long only because they contain guidance and explanations which are for you and which you will not include in the informed consent forms that you develop and provide to participants in your research.
  • These templates include examples of key questions that may be asked at the end of each section, that could ensure the understanding of the information being provided, especially if the research study is complex. These are just examples, and suggestions, and the investigators will have to modify the questions depending upon their study.
  • In these templates:
    • square brackets indicate where specific information is to be inserted
    • bold lettering indicates sections or wording which should be included
    • standard lettering is used for explanations to researchers only and must not be included in your consent forms. The explanation is provided in black, and examples are provided in red in italics. Suggested questions to elucidate understanding are given in black in italics.

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