The following is an example consent statement which could be put at the begining of a survey. You are welcome to use it as a starting point for creating your own consent form, however, you will need to modify it to fit your survey.

For example, this consent form says that you are studying University of Edinburgh students, if you plan on sending your survey to other students you should modify this part. Similarly it says that you are interested in how people use current tools, if you want to ask about how they might use a theoretical new system you will need to modify this part.

Consent Statement Example

We are students in the Human-Computer Interaction course. For our first coursework we are studying how students at the University of Edinburgh use calendaring systems such as paper calendars, Google Calendar, and Office 365 Calendar.

In this survey we are investigating how people use their online calendars so that we can better understand their calendar-related needs and choices. We will ask you for some information about yourself, about the way in which you use computers and the internet, about the tools you use to manage your timetable and other events.

Completing the survey will take about 10 minutes. You can interrupt the survey at any time and return to finish it later. All the data that you provide will be stored on [list your survey provider] and user-level access will be restricted to our group. Questions marked with a red star are mandatory - you will need to answer them in order to complete the survey.

This project has undergone ethical screening in accordance with the University of Edinburgh School of Informatics ethics process (RT1432).

Do you agree to take part in this study, and do you agree that I can use your data for my HCI student project.

Yes / No

Consent statements must include

A good concent form contains all of the following:

Who you are. You need to clearly state who you are, who you represent, and who the participants should complain to if they think you are violating any ethical rules.
What you are asking the participants to do. You need to clearly state what being part of the study involves. Will you be asking them about calendars? Private events? Will they be taking a test or watching videos?
What kind of data you will be collecting and how it will be used. You need to clearly list all the types of data you plan on collecting from the participant. For interviews this may be audio data, for surveys this may be data provided via the questions (note that surveymonkey collects IP addresses). You also need to clearly state what you will be using the data for and how you will protect it. For example, you may say you will delete it one month after the coursework deadline, or that you will remove all the personally identifying information (or better yet, never collect any).
What rights the participant has. Typically they have the right to stop taking a survey, or stop an interview at any point. You may also give them the right to skip questions they do not feel comfortable with. In some interviews I tell participants that they have the right to turn off the audio recording at any time.
If they will be compensated. If you will be providing compensation (coursework should not do this) you need to clearly state what it is, and if the participant will be given the compensation if they choose to leave the study early. When I do studies with no compensation I often say that they will "receive no compensation beyond the knowledge that they have advanced science".
The participant must explicitly say "yes" to the consent form.

Advertisement example

We are students in the Human-Computer Interaction course, and we are looking for people to participate in a survey on calendar systems. The survey should take about 10 minutes to complete and will ask you about the way in which you use computers and the internet, and about the tools you use to manage your timetable and other events.

The survey does not ask you for any identifying information and the responses will be used only for our coursework. Collected information will be deleted once our coursework is completed.

Advertisements must include

Advertisements for studies contain many of the same elements as the consent form, but shorter. The most important are short statements about the following:

Who you are.
What you are asking them to do.
Compensation (if it exists)
If you are collecting non-obvious data or the data is beng stored in a non-obvious place, then you need to say so.

University ethics requirements

The instructor for HCI has filled out a Level 1 ethics form using the Informatics proceedures. Please review the filled out form so that you are aware of what the form looks like and what we have agreed to. If you need to do a study involving human subjects for your UG4 or MSc projects, you will need to fill out a similar form and have hit approved.

UG4/MSc Projects

If your UG4 or MSc project requires a consent form you will need to do a bit more work. Consent forms for class projects where the risk to participants is extremely low and the results will not be published can use a simple statement like the one above. For projects where the work may be published you need to go through an ethics approval process with your supervisor and provide the approval number on your consent form along with the contact information for both you and your supervisor.