I, ____________________________, as a legally nominated representative of ______________________________________, have been fully informed of the project (insert the objectives of the project; the partners and nature of partnership, funding, outcomes and benefi ts; what the recipient / researcher expects from the provider, including any targets that may be envisaged; assurance of authenticity; etc.). __________________________________________________________________ ________________________________________________________________ __________________________________________________________________ ______________________________________________________________
Commitment of the Recipient Include the following information:
1. The research process emphasizing what the recipient will do in and/or for the community
2. Key principles that will be observed such as:
b) Respect and cultural sensitivity;
e) Equity; and
f) Indigenous guardianship.
3. Conditions Associated with the Project Include explanations of all conditions that may affect the Provider such as:
a) Life of the agreement;
c) Amendment; and
4. Commitment of Representative of the Provider
The representative of the Provider must be made aware of his / her role and rights in the project. Commitment should be obtained on:
a) Willingness to represent provider (community);
b) Legal nomination of the representative;
c) Freedom to withdraw from the project (in person) at any time without affecting the project; and
d) Freedom to withdraw the community participation from the project, without jeopardizing future projects.
Signature of TK holder / practitioner: _______________________________ Date: _____/______/20____
Signature of TK recorder who obtained informed consent: _______________ Date: _____/______/20____
Signature of witness: _____________________________________________
Append documents mentioned in the agreement as appropriate.
(Note: Care must be taken to avoid the indiscriminate use of technical jargon and, where appropriate, the document should be translated into local languages)
Title of Project: __________________________________________________________________ Synopsis of the Project (Clearly summarize what the project is about, the objectives, the partners, the outcome, benefits etc.)
Contribution of the Provider
Explain what the Recipient / Researcher expects from the Provider, including any targets that may be envisaged and assurance of authenticity.
Rights of Project Partners Include explanations on:
b) Amendment; and
Invite the Provider to feel free to ask any questions about the project.
Contacts: Include contact details of key project personnel