Consent Form
I, ______, agree to participate in this research titled ______which is being conducted by ______, Spanish 4160, Department of Spanish, Dr. Hislope – supervising instructor, 706-864-1427. I understand that my participation is entirely voluntary; I can withdraw my consent at any time without penalty and have the results of my participation, to the extent that they can be identified as mine, returned to me, removed from the research records, or destroyed.
The following points have been explained to me:
1. The present research is being conducted to study different aspects of the Spanish language among native and non-native speakers.
2. The procedures are as follows:
(Describe what will happen to the participant, including the time, place, and duration. If administering questionnaires, give a brief descriptive phrase about each. In clinical studies involving experimental treatments, identify the parts that are new or experimental. If deception is necessary, state: "In order to make this study valid, some information about my participation will be withheld until after the study.")
3. No discomforts or stresses are foreseen.
4. No risks are foreseen.
5. The results of this participation will be anonymous.
6. The investigator will answer any further questions about the research, now or during the course of the project
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Signature of Research ParticipantDate
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Signature of ExperimenterDate
PLEASE SIGN BOTH COPIES OF THIS FORM. KEEP ONE AND RETURN THE OTHER TO THE INVESTIGATOR.
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Research at University of North Georgia that involves human participants is overseen by the Institutional Review Board. Questions or problems regarding your rights as a participant should be addressed to Dr. Teresa Fletcher, IRB Chairperson, Department of Clinical and Mental Health Counseling, University of North Georgia, Dahlonega, GA 30597; Telephone: (706) 867-2796; e-mail:
Formulario de Consentimiento
Yo, ______, consiento en participar en este estudio titulado ______. Los investigadores son ______, Español 4160, Departamento de Español, Dra. Hislope – supervisora, 706-864-1427. Entiendo que la participación es completamente voluntaria. Puedo salirme del estudio en cualquier punto del mismo sin penalidad alguna y los resultados de mi participación me serán devueltos, quitados del estudio, o destruidos.
Los siguientes puntos me han sido explicados:
1. Este experimento es para estudiar diferentes aspectos de la lengua española de los hablantes
nativos y no-nativos.
2. El procedimiento es el siguiente:
3. No hay incomodidades o estreses conocidos.
4. No hay riesgos conocidos.
5. Los resultados de este estudio serán anónimos.
6. El/La investigador/a responderá a cualquier pregunta ahora o durante el proyecto.
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Firma de participante Fecha
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Firma de investigador/aFecha
Favor de firmar ambas copias de este formulario. Guarde una copia y devuelva la otra al (a la) investigador/a.
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Las investigaciones de la Universidad de North Georgia que usan participantes humanos son supervisadas por el “Institutional Review Board (IRB)”. Si tiene preguntas o problemas en cuanto a sus derechos como participante, por favor hable con Dra. Teresa Fletcher, Chairman of the (Jefe del) IRB, Depto. de Clinical and Mental Health Counseling, Universidad de North Georgia, Dahlonega, GA 30597; teléfono (706) 867-2796; correo-electrónico . Para hablar con la profesora del investigador en español, llame al (706) 864-1427.