UniMelb Research Participation and Data Processing Consent Form Template

CONSENT FORM: RESEARCH PARTICIPATION AND DATA PROCESSING

DOCUMENT CONTROL

• Effective Date: [Insert Date]
• Version: 1.0
• Jurisdiction: Victoria, Australia
• Scope: University of Melbourne (UniMelb) Research/Project Compliance

1. OFFICIAL NOTICE / DISCLAIMER

LEGAL NOTICE: This document is designed to facilitate informed consent in accordance with the National Statement on Ethical Conduct in Human Research (2007, updated 2018) and the Privacy Act 1988 (Cth). It does not constitute legal advice. It is the responsibility of the Principal Investigator to ensure this document is reviewed and approved by the appropriate Human Research Ethics Committee (HREC) prior to deployment.

2. PARTIES & DEFINITIONS

• "The University": The University of Melbourne, a body politic and corporate established pursuant to the University of Melbourne Act 2009 (Vic).
• "The Participant": [Full Legal Name of Participant], residing at [Residential Address].
• "The Research": [Formal Title of Project/Study], HREC Protocol Number: [Insert HREC ID].

3. OPERATIVE CLAUSES & TERMS

1. Voluntary Participation: The Participant acknowledges that participation in the Research is entirely voluntary. The Participant reserves the right to withdraw from the Research at any stage without prejudice or penalty.
2. Informed Consent: The Participant confirms they have read the Plain Language Statement provided and have had the opportunity to ask questions regarding the study’s purpose, duration, and potential risks.
3. Data Governance: The Participant authorizes the University to collect, store, and process personal and sensitive information in accordance with the University’s Privacy Policy. Data will be de-identified where practicable and stored securely on University-approved encrypted servers.
4. Use of Data: The Participant grants the University an irrevocable, royalty-free license to use data collected during the Research for academic publication, dissemination, and secondary research purposes, provided the Participant remains de-identified unless explicit prior authorization is granted.
5. Retention: Data will be retained in accordance with the Public Records Act 1973 (Vic) and University retention schedules.
6. Governing Law: This agreement is governed by the laws of the State of Victoria, Australia. Any disputes arising hereunder shall be subject to the exclusive jurisdiction of the courts of Victoria.

4. ACKNOWLEDGMENT & SIGNATURE BLOCK

I, [Participant Name], confirm that I have reached the age of majority and possess the legal capacity to provide this consent. I acknowledge the terms above and agree to participate in the Research described.

Participant Signature: ___________________________ Date: [DD/MM/YYYY]

Principal Investigator Signature: ___________________________ Date: [DD/MM/YYYY] (Name: [Insert Name] | Department: [Insert Department])

5. STEP-BY-STEP EXECUTION GUIDE

• HREC Verification: Prior to the collection of any signatures, ensure the project protocol and the specific wording of this consent form have received formal approval from the University of Melbourne HREC.
• Execution Protocol: Obtain wet-ink signatures or utilize an e-signature platform compliant with the Electronic Transactions (Victoria) Act 2000. A copy of the signed document must be provided to the Participant immediately upon execution.
• Secure Archival: Store the fully executed document in a restricted-access digital folder (e.g., University-approved SharePoint or Research Data Store) with audit logs enabled to maintain compliance with institutional data retention policies.
• Versioning Control: If the research scope changes, a fresh consent form must be executed; do not append amendments to existing signed documents.