University of the Philippines

College of Arts and Science Department of Behavioral Sciences

Padre Faura, Ermita, Manila
INFORMED CONSENT FORM

Good day!
You are being invited to participate in a research about the experiences of Filipino gay
elderlies in relation to abuse and abandonment through taking part in an in-depth
interview. Before deciding, kindly read the following information carefully and feel in
concerns about the study. Thank you! This informed consent is divided into two parts:
 Information sheet
 Certificate of consent

Information Sheet
Introduction
I am _________, a senior BA Behavioral Sciences student from the University of the
Philippines. I am doing a study under the supervision of __________ the lived experience of
Filipino gay elderlies in relation to abuse and abandonment.

Title of the Research: Life Narratives of Filipino Elderly in Home for the Golden Gays

Purpose of the Research:

Acts of elderly abuse remains a serious social problem but taken as a private matter. There
has been an exclusion of lesbian, gay, bisexual and transgender (LGBT) elders on the
discussion of elder abuse. This study aims to explore on the lived experiences of gay
elderlies related to abandonment and abuse. I would also like to pre-empt you that there
may be sensitive questions in the interview.

Participants and Recruitment

Six participants will be needed for the study. In cooperation with the Home for the Golden
Gays organization president, Ramon Busa, six members fit for the study will be encouraged
to participate.

Type of Research Intervention

This research will employ the use of recording devices. I understand that you may want to
remain anonymous, with this, you can use an alias in introducing yourself.

Voluntary Participation
Your participation in this research is entirely voluntary. You may withdraw from the study,
is ever you change your mind later. You have the right to refuse or withdraw from our
invitation to participate in this research endeavour.

You are free to use Tagalog or English in answering interview questions

Duration
The interview will take about 30 minutes to an hour.

Risk
There are no directly perceived risks towards you, the informant, but there are sensitive
won included in the in-depth interview to be utilized for this research.
Benefits
The research will not benefit you directly, but this interview would contribute to me on the
experiences of Filipino gay elderlies.

Confidentiality
My supervisor and I will only know the information you are about to share. I will not be
sharing information about you to anyone outside of the research. In presentation the study,
I will use a number or a different name (alias) to report.

Sharing the Results

The knowledge that we will gather will be shared only to the professors of the Department
of Behavioural Sciences. The organization will be given a copy of the research

Who to Contact For any questions

You may contact ______________ at ____________ or _________

The Researchers:

II. Certificate of Consent

I confirm that I have read and understood the foregoing information, or it has been read to
me.
I understand that my participation is voluntary and that I am free to withdraw at any time
without any negative consequences.
I understand that I may decline to answer questions I find sensitive.
I understand that my responses will be kept strictly confidential.
I have had the opportunity to ask questions about it and any questions
I have asked have been answered to my satisfaction. I give my permission for the research
team members to have access to my anonymized responses.
I agree to take part in the research as described above.

Printed Name of the Participant (Alias) :

Signature of the Participant: __________

Date (dd/mm/yyyy): _______
 Unibersidad ng Pilipinas
Kolehiyo ng Agham at Sining Departmento ng Dalub-asal
Padre Faura, Ermita, Manila
INFORMED CONSENT FORM
Magandang Araw!
Kayo po ay napili na lumahok sa pananaliksik ukol sa karanasan ng Filipino gay elderlies, na
may ugnayan sa abuse and abandonment. Nais ko po sana kayong makapanayam at
makakwentuhan tungkol sa nasabing paksa. Maari lamang po sana na basahin niyo ang
eksplanasyon tungkol sa pananaliksik na nakasaad sa baba. Magtanong lamang po sa aki
kung may mga hindi malinaw o hindi ninyo maintindihan na bahagi ng eksplanasyon.
Maraming salamat po!
Ang informed consent na ito ay nakahati sa dalawang bahagi:
• Information sheet
• Certificate of consent

Information Sheet
Introduksyon
Ako po si.
estudyante sa Unibersidad ng Pilipinas na nasa ikaapat na taon ng pagaaral ng BA
Behavioral Sciences, sa ilalim ng superbisyon ni
Ako po ay nagsasagawa ng pananaliksik tungkol lived experience of Filipino gay elderlies,
na may kaugnay sa abuse and abandonment.

Pamagat ng Pananaliksik
Life Narratives of Filipino Elderly in Home for the Golden Gays

Dahilan ng Pananaliksik
Ang insidente ng pang-aabuso ay nanatiling seryosong problema na tinatago sa lipunan.
Hindi gaanong nabibigyan ng boses and mga lesbian, gay, bisexual and transgender (LGBT)
elders sa diskusyon ng paksa. Ang pananaliksik na ito ay naglalayon na talakayin ang
karanasan ng mga Filipino gay elderlies na may kaugnayan sa abandonment and abuse. Nais
ko lamang kayo babalaan na maaring may mga sensitibong tanong sa panayam.

Partisipasyon
Anim na kalahok ang kinakailangan sa pananaliksik. Sa tulong ng lider ng Home for the
Golden gays, na si Ramon Busa, anim na miyembro ay hihikayating sumali sa pananaliksik.

Uri ng Pagrecord sa Pananaliksik

Ako po ay gagamit ng audio recording device sa loob ng panayam. Maari po kayong
mumamit ng alias, upang manatiling anonymous.

Boluntaryong Partisipasyon
Ang inyong partisipasyon sa pag-aaral ay boluntaryo. Maari kayong umayaw bilang maging
kalahok anumang oras. Mayroon kayong karapatan na hindi tanggihan ang imbitasyon na
lumahok sa pananaliksik Maari kayong gumamit ng Ingles o Tagalog sa pagsagot ng mga
tanong sa panayam.

Tagal ng Panayam
Ang panayam ay maaring tumagal ng 30 minuto hanggang isang oras.
Panganib ng Pananaliksik
Walang direktang panganib ang pananaliksik sa inyo, ngunit may mga sensitibong paksa sa
kasama sa panayam.

Benepisyo ng Pananaliksik
Walang direktang benepisyo ang pananaliksik sa inyo, ngunit ang panayam ay
makakatulong sa pagtalakay ng karanasan ng Filipino gay elderlies.

Pagiging Kompidensyal
Tanging ako at ang aking guro lamang ang makakaalam ng mga impormasyong inyong
ibabahagi. Hindi ako magbabahagi ng impormasyon sa labas ng pananaliksik. Sa
presentasyon ng resulta ng pananaliksik, gagamit ako ng bilang o alias.

Pagbabahagi ng Resulta Tanging

Ang mga propesor lamang ng Departamento ng Behavioral Sciences ang makakaalam ng
resulta ng pananaliksik. Ang organisasyon ay makakatanggap din ng kopya ng pananaliksik.

Sino ang maaring Kausapin Kung kayo ay may katanungan tungkol s apagaaral na ito,
pwede niyot po akong tawagan sa __________
17 o sa aking e-mail address na : _____________

Mananaliksik:

II. Certificate of Consenr

Ang aking paglagda ay nagpapatunay na:
Nabasao o binasa sa akin at naiintindihan ko ang mga nasabing impormasyon
Naiintindihan ko na ang aking partisipasyon ay boluntaryo at maari akong lumiban na
walang masamang kapalit.
Naiintindihan ko na maari kong hindi sagutin ang mga sensitibong katanungan
Naiintindihan ko na ang aking mga ibabahagi ay mananatiling kompidensyal.
Nagkaraoon ako ng opportunidad na magtanong ang anumang hindi malinaw sa akin.
Ibinigay ko ang aking permiso sa mananaliksik na gamiting ang aking mga sagot sa pag-
aaral.
Pumapayag ako na maging kalahok sa pananaliksik.

Pangalan ng Kalahok (Alias):

Lagda ng Kalahok:
Petsa (dd/mm/yyyy):