Consent to Use Personal Information in a Research Study

Report: “Harassment and Discrimination at UBC”

1. WHO IS CONDUCTING THIS SURVEY?

Graduate Student Society - UBC Vancouver
Ad Hoc Committee on Harassment and Discrimination
225 – 6371 Crescent Road
University of British Columbia
Vancouver, BC V6T 1Z2
gss.ubc.ca

2. WHY ARE WE CONDUCTING THIS PROJECT?

This project is being conducted to learn more about graduate student experiences of harassment and discrimination at the University of British Columbia [UBC]. It specifically explores topics such as: incidences of harassment and discrimination, the reporting process, campus resources, and the outcome or response from UBC. We are using this information to inform the Committee`s research on how to best address graduate student harassment and discrimination at UBC.

3. WHAT WILL YOU BE ASKED TO DO?

If you choose to participate, you will be asked to submit a story of your experience with discrimination and/or harassment as a UBC Graduate Student. You may elect to submit this story online through the mygradstory.ca website, an email to confidential@mygradstory.ca or in person via a one-on-one interview in a semi-private location on UBC campus (ie. a GSS office or a location of your choosing). If you wish to submit your story via a one-on-one interview, the interview will be audio-recorded and transcribed. However, you may ask that the audio-recorder be turned off at any point.

Prior to submitting your story, you will be asked to provide your written consent that you willingly agree to participate in the project. Consent can be revoked until the final report is published (publication date is estimated to be summer of 2016).

After your interview, and before the data are included in the final report, you will be able to review the transcript of your interview, and to add, change or delete information from the transcripts as you see fit.

You can request a copy of the results of this project.

4. HOW WILL THE INFORMATION BE USED?

The information that is gathered will be used in the production of a report that will be presented to the GSS Council and to UBC; the report will contain policy and procedure recommendations for how UBC may be able to better address graduate student harassment and discrimination. If you give us permission (optional), redacted quotes containing no personal information from your story may be used for advocacy purposes.

The Harassment and Discrimination Committee will provide you with copies of the report that results from this study upon your request.

5. WHAT ARE THE BENEFITS OF PARTICIPATING?

As a result of this project, we may learn more about the forms of harassment and discrimination that exist at UBC. Recommendations about how to address incidents of harassment and discrimination will be generated.

6. IS THERE ANY RISK TO YOU FROM PARTICIPATING?

It is not likely that you will be harmed by participation in this project. Your participation in this project could affect your relationships at UBC with other students, staff and faculty.

It is possible that you may become emotionally or psychologically upset during the process of participating in this study. There is a list of support resources you are able to access at you.ubc.ca/ubc-life/support/. If you choose to participate in a one-on-one interview, you reserve the right to end the interview at any point and exit the project.

Every effort will be made to maintain the level of confidentiality requested in this consent form; however, an absolute guarantee of confidentiality cannot be provided. The Harassment and Discrimination committee would be obligated to share confidential information with authorities in the event there is evidence you may harm yourself or others. Also, while highly unlikely, the Committee can be required to surrender information, if ordered to do so by a court.

7. HOW WILL YOUR IDENTITY BE PROTECTED?

No information that discloses your identity or the identities of others will be published. If you consent to allow the Harassment and Discrimination Committee to quote your statements in publications, you can note if there are statements you would like to remain confidential.

If you wish statements to be kept confidential, the Harassment and Discrimination Committee will take the utmost care to protect the details of your responses and your participation in this project. The data you are submitting electronically is received in a password-protected account that can only be accessed by one member of the Harassment and Discrimination Committee.

Stories will be redacted to remove any personally identifying information before being shared with the rest of the Committee. Your story will not be discussed by Committee members outside of the purposes of this project. All information will be stored in a locked secure location and on an encrypted USB. All data will be destroyed after the publication of the Final Report.

In the event a consent form is not completed, information will only be reported as part of an aggregated data set about harassment and discrimination occurring at UBC. We won’t report what we learn about any one person. We will only write about the combined responses of groups of people. For example, we might say that 20% of our participants answered XYZ.

8. WHOM CAN YOU CONTACT IF YOU HAVE QUESTIONS ABOUT THE STUDY?

If you have any questions or desire further information about this study, you may contact the Harassment and Discrimination Committee at confidential@mygradstory.ca.

9. PARTICIPANT CONSENT OPTIONS

Please carefully review the options provided below and indicate your consent about how the information you provide to the Harassment and Discrimination committee will be used.

Right to Refuse or Withdraw

Taking part in this survey is entirely up to you. You have the right to refuse to participate in this survey.

You have the right to omit information, as well as to withdraw completely from study and withdraw the information you submitted at any point during the process.

In order to provide clear consent, you are required to agree to one of the options for each item below.

By checking the boxes below, you shall indicate how you wish the information you will provide/provided on mygradstory.ca or in an interview with the GSS Ad Hoc Committee on Harassment and Discrimination to be shared or used.

1. I agree to participate in this study.

 Yes No

2. I understand that the Committee’s Report will be provided to the GSS Council, various UBC administrators and possibly made public.

 Yes No

3. I permit information from my submission to be directly quoted in the Committee’s report.

 Yes No

4. I permit information from my submission to be referred to in general summaries about discrimination and harassment at UBC.

 Yes No

5. I permit information derived from my submission to be used only as a part of an aggregated data set about harassment and discrimination occurring at UBC.

 Yes No

BY CHECKING THE BOX BELOW, YOU ARE SIGNING THE CONSENT FORM AND ACKNOWLEDGING THE FOLLOWING: I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS CONSENT FORM PRIOR TO SIGNING IT, AND I AM AWARE THAT BY SIGNING THIS FORM I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES.
  Yes, I have read and understood all the terms and conditions of this consent form

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Signed this on this date:*

Please use this date format: January 1, 2016