SayPro Ethics and Consent Declaration Form (SayPro Template #ECD01)

SayPro Ethics and Consent Declaration Form

Template Code: SayPro Template #ECD01
Issued by: SayPro Research Ethics Office
Required For: All SayPro research involving human participants, personal data, or community-based fieldwork

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SayPro Section 1: Research Project Information

Field	Description
Project Title	Full title of the research or case study
Project Code	Internal SayPro tracking ID (if applicable)
Lead Researcher	Full name and position
Research Team Members	Names of co-researchers, assistants, or collaborators
Associated SayPro Unit/Program	e.g., Economic Impact Studies, Social Inclusion Program
Date of Submission	DD/MM/YYYY

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SayPro Section 2: Ethics Declaration by Researcher

Please confirm the following statements by ticking the boxes:

Declaration Statement	Yes / No / N/A
I confirm that this study adheres to SayPro’s Code of Ethics for research.	☐ Yes ☐ No
I confirm that informed consent will be obtained from all participants.	☐ Yes ☐ No
I confirm that participants can opt out at any stage without consequence.	☐ Yes ☐ No
I confirm that no personal data will be collected without consent.	☐ Yes ☐ No
I confirm that data will be stored securely and anonymously where applicable.	☐ Yes ☐ No
I confirm that risks to participants have been assessed and minimized.	☐ Yes ☐ No
I confirm that local cultural, legal, and community standards have been considered.	☐ Yes ☐ No

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SayPro Section 3: Participant Consent Process

Item	Description
Consent Method	☐ Written Consent ☐ Verbal Consent ☐ Digital Consent
Language Used	Languages in which consent will be obtained
Consent Form Attached	☐ Yes ☐ No
Are minors or vulnerable populations involved?	☐ Yes ☐ No

If yes, include guardian consent protocols and additional safeguards.

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SayPro Section 4: Risk and Mitigation Overview

Risk Identified	Mitigation Strategy
e.g., Disclosure of sensitive personal data	Anonymization and secure data handling
e.g., Participant distress during interviews	Use of trained facilitators and opt-out options

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SayPro Section 5: Researcher Declaration and Signature

“I, the undersigned, confirm that I understand and accept my ethical responsibilities in the conduct of this research. I will adhere to SayPro’s ethical guidelines and ensure the safety, rights, and dignity of all research participants.”

Name	Signature	Date
Lead Researcher
Co-Researcher(s) (if applicable)

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SayPro Section 6: SayPro Ethics Committee Use Only

Review Stage	Status	Reviewed By	Date
Ethics Review	☐ Approved ☐ Revisions Needed
Comments

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📝 Submission Instructions

• Submit this form along with your SayPro Research Planning Worksheet (#RPW01) and Consent Form samples to:
  ethics@saypro.org or via the SayPro Research Compliance Portal.
• Use subject line: [Ethics Declaration – Template #ECD01 – Project Title]

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✅ Notes

• This form must be submitted before any fieldwork or data collection begins.
• Projects involving external partners may require additional clearance from local/national ethics boards.

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