UW Oshkosh
Office of Sponsored Programs and Faculty Development
ExampleInformedConsentDocumentforConducting Audio-Recorded Interviews
UNIVERSITYOFWISCONSINOSHKOSH
ResearchParticipantInformationandConsentFormTitleoftheStudy: <Title>
PrincipalInvestigator:<PIName,ContactInformation>
DESCRIPTIONOFTHERESEARCH
Youareinvitedtoparticipateinaresearchstudyabout<InsertDescription>. Thegoalis<InsertResearchObjectives/Purpose>.
WHATWILLMYPARTICIPATIONINVOLVE?
<Describe procedures> Youwillselectwhere youwouldliketobeinterviewed,whichcanincludeinpersonataplaceofyourchoice,overthephone,orSkype.Audiorecordingswillbemadeofyourparticipation.Iwillbethe onlyonewhowillheartheaudiorecordings,whichwillbetranscribedbyme. The audio recordings will be destroyed once the transcription is complete. Data willbewrittenup,submittedforpublication,andpresentedataconference. <Optional insert:Datamaybeusedinfutureresearchprojects.> <Include frequency and duration of participation, i.e. Youwillbeaskedtoparticipatein1-3interview(s)lastingapproximatelyonehourpersession.Youwillbegiventheinterviewquestionsinadvance.Imayalsowanttoreviewsomeof yourdocuments,whichcouldincludecoursesyllabiand/orinstructionalmaterial.
ARETHEREANYRISKSTOME?
Thisstudyposesminimalconfidentialityrisks.No personally identifiable information will be shared outside of the interviews, however withaverysmallsamplesize,itispossibleparticipantscouldbeidentifiablebasedontheirresponses.Riskswillbeminimizedbyusingpseudonymsinthedata,analysis,andanypublicationtoprotecttheconfidentialityoftheparticipants.
ARETHEREANYBENEFITSTOME?
Therearenodirectbenefitstotheindividual.Benefitstosocietymayinclude<InsertBenefits>.
WILLIBECOMPENSATEDFORMYPARTICIPATION?
Youwillreceivea$25giftcardforparticipatinginthisstudy.If youwithdrawpriortotheendofthestudy,youwillstillreceivethe$25giftcard.
HOWWILLMYCONFIDENTIALITYBEPROTECTED?
MycomputerwillrequireapasswordthatonlyIwillknowtobeenteredwhenitisturnedon.Iwillusepseudonymsinthedata,analysis,andanypublicationtoprotecttheconfidentialityoftheparticipants.Iwillincludepasswordprotectionondocumentsthathaveparticipantdata,includingrecordedortranscribeddocuments. <Insert when audio recordings be destroyed?> IfinterviewsareconductedoverthephoneorSkype,Iwilldothis frommyofficeinprivacywiththedoorclosed.If youparticipateinthisstudy,wewouldliketobeabletoquote youdirectlyusing a pseudonym in place of yourname.If youagreetoallowustoquote youinpublications,pleaseinitialthestatementatthebottomofthisform.
WHOMSHOULDICONTACTIFIHAVEQUESTIONS?
Pleasecontactmewithanyquestionsabouttheresearch,<PINameContactInformation.
If youarenotsatisfiedwithresponseoftheresearchteam,havemorequestions,orwanttotalkwithsomeone independent of the researcheraboutyourrightsasaresearchparticipant,youmaycontacttheIRBChair:
Chair,InstitutionalReviewBoardForProtectionofHumanParticipants
c/oOfficeofGrantsandFacultyDevelopmentUWOshkosh
Oshkosh,WI54901
(920)424-1415
Yourparticipationiscompletelyvoluntary.Youhavetherighttowithdrawatanytimeduringthestudy.Uponthe completionofthestudy,Iwillbehappytodiscussthefindingswith youif yourequesttodoso.
Sincerely,
<PIName>
<University>
<Department>
CONSENT
Yoursignatureindicatesthatyouhavereadthisconsentform,hadanopportunitytoaskanyquestionsaboutyourparticipationinthisresearch,andvoluntarilyconsenttoparticipate.Youwillreceiveacopyofthisformforyourrecords.
Igivepermissionfortheinterviewtoberecordedfortranscriptionpurposes.
Igivemypermissiontobequoteddirectlyinpublicationswithoutusingmyname.
NameofParticipant(pleaseprint):
Signature of ParticipantDate
------______Signature of Principal Investigator Date