Survey consent form – Non-BREB projects – Sample

Project Title

Dear students,

As part of the ​[course number/name] ​course ​​you were asked to [practice/pedagogy/activity that was implemented]​. We hope that by answering this​ [XX​ minute] survey, you can help the course instructors understand whether these processes/activities​ [helped reach a specific outcome/facilitated a specific learning process]​. This will help us improve the course activities for future students.

Your responses are collected and analyzed by ​[name of person in charge]​. ​If you have any questions or concerns about your participation please contact ​[name and email]. Your participation in this survey is anonymous [if no identifying information is collected], voluntary and will not impact your grade. Your instructor will not see the data until final grades have been submitted. Aggregate data and/or anonymized quotes may also be shared publicly, to share the results of the teaching and learning inquiry into ​[tool/program/practice/activity]​.

CONSENT
Your participation in this study is entirely voluntary and you may refuse to participate or withdraw from the study at any time. By completing this survey you consent to participate in this study and having your responses included in the analyses.