Consent Form 
 
•	This project ‘CHRONIC ILLNESS AND ONLINE NETWORKING’ – is being conducted by the research team at the University of Leicester and Queen Mary University of London. It is funded by the Economic and Social Research Council (ESRC).
•	All data will be treated as personal under the 1998 Data Protection Act, and will be stored securely.

Please tick the appropriate boxes	Yes	No	
Taking Part			
I have read and understood the project information sheet.	
					
I have been given the opportunity to ask questions about the project. 
			
I agree to take part in the project.  Taking part in the project will include being interviewed and recorded (audio or video).			
I understand that my taking part is voluntary; I can withdraw from the study at any time and I do not have to give any reasons for why I no longer want to take part.
			
Use of the information I provide for this project only			
I understand my personal details such as phone number and address will not be revealed to people outside the project.
			
I understand that my words may be quoted in publications, reports, web pages, and other research outputs.
			
Please choose one of the following two options:
I would like my real name used in the above 
I would not like my real name to be used in the above.

	

Use of the information I provide beyond this project 			
I agree for the data I provide to be archived at the UK Data Archive.
			
I understand that other genuine researchers will have access to this data only if they agree to preserve the confidentiality of the information as requested in this form. 
			
I understand that other genuine researchers may use my words in publications, reports, web pages, and other research outputs, only if they agree to preserve the confidentiality of the information as requested in this form.
			
So we can use the information you provide legally 			
I agree to assign the copyright I hold in any materials related to this project to Nelya Koteyko.			

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Name of participant	[printed]	Signature		             Date

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Researcher		[printed]	Signature	   	             Date

Project contact details for further information:  Dr Nelya Koteyko, 0116 252 2768, n.koteyko@qmul.ac.uk. Address: Language Centre, SFFL, Frances Bancroft Building, Queen Mary, University of London, Mile End Road, London E1 4NS.

This work is licenced under the Creative Commons Attribution-Non-Commercial-Share Alike 2.0 UK: England & Wales License. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-sa/2.0/uk/