Sample Consent Form Format
(The purpose of this sample form is to streamline the IRB approval process by assisting investigators in remembering to include all required elements of informed consent.)
Invitation to Participate in Research Project
Welcome potential participants; specify that the endeavor is research and that
participation is voluntary.
Purposes, Procedures, and Duration of the Study
Describe, to the extent possible, the purposes of the study.
Describe, to the extent possible, the procedures that will be used. (Avoid disciplinary jargon; phrase these sections in plain English.)
Give a reasonable estimate of the time involved to complete the study.
Possible Benefits and Risks of Participation
How, if at all, will this study benefit the participants?
If not of immediate benefit to the participants, how might it be expected to benefit future generations?
If any incentives (money, food, etc.) are offered to potential participants, describe these.
If participants are offered access to the study’s results, specify where, when, how, and from whom these are to be obtained.
Risks may include anxiety about performance, giving answers that may threaten the way participants are viewed by the investigator, threats to self-esteem, etc. even if the project poses no physical and/or medical risks.
Your Options Regarding Participation and Continuation
Be explicit that people may choose to participate, or choose not to participate. Non-participants must be clear that this choice will not result in penalty or loss of benefits to which they would otherwise be entitled.
Be explicit in stating that persons who choose to participate may change their minds without being hassled in any manner about this choice.
If the research involves students and will take place during class sessions, specify
what non-participants will do during the research project (be dismissed
early, etc.)
Confidentiality and Disclosure of Responses
Responses are only anonymous if names or other identifying information is/are
not retained in any form.
If any identifying information is retained, the best you can promise is confidentiality. You should specify where the data will be kept and who (# of persons and their statuses) will have access to the data, where it will be reported (conferences, journals, etc.) and in what format (group responses? Quotes from individuals? A combination thereof?)
Are you recording the participants in any manner? If so, confidentiality is more likely to be compromised. Who will have access to these recordings? Where will they be stored? For how long? When and how will they be destroyed?
Whom to contact
Add the contact information for the IRB Coordinator here, noting that participants should contact this person if any research-related problems arise and/or if they have questions about the rights of subjects in research.
Agreement to Participate (or Not)
This should include a brief summary of your study and what you are asking participants to agree to. To be clear that participation is a choice, and to maintain the privacy of each person’s choice, it is preferred that this form include a signature space including both of the following:
Having read this consent form, and after asking any questions that I have about the procedures, benefits, and/or risks of this study, I hereby agree to participate in this study of <topic>. I also understand that I may withdraw from participation at any time without penalty. My signature also indicates that I have received a copy of this form.
______
Signature Date Print name here
Having read this consent form, and after asking any questions that I have about the procedures, benefits, and/or risks of this study, I have decided to decline to participate at this time. However, if I later decide to participate, I understand that I may contact <person> to see if this study or a related study is in progress. My signature also indicates that I have received a copy of this form.
______
Signature Date Print name here
If minors (including students under the age of 18) are to be included, the consent form must also state that consent of a parent is also required before participation may begin, and a space should be allocated for parental signature.