Example of Informed Consent form[JRM1]
Signature Required
I am Harry Fan, a psychology student at Troy University, and I am conducting a study under the supervision of Dr. Bob Apples. [JRM2]The purpose of this study is to investigate factors that increase the motivation of athletes to attend practice.[JRM3][JRM4]You are being asked to participate in this study because you are a member of the TROY Polo club.
If you choose to participate, you will be asked to complete a survey concerning what motivates you to attendpolo practices. Completing the survey should take no longer than 15 minutes. [JRM5]I also will use the coaches’ attendance records to track how many practices you actually attend. [JRM6]
There are no risks to your participation in this research. [JRM7]By participating in this study, you may obtain a better understanding of your motivations for attending practice. Further, the results of this study may help coaches better understand what motivates athletes to attend practices.[JRM8]
Only Harry Fan and Dr. Bob Apples will have access to your data. Your data will be kept in Dr Apples’ office for three yearand will then be destroyed. Any publications or presentations based on this research will refer to individual participants using code names or will present data in group form so that no participant can be identified.[JRM9]
Your participation is entirely voluntary and you may refuse to participate or discontinue participation at any time without penalty. Your decision about whether or not to participate will not affect your relationships with the researchers, your coach, your standing on the team, your relationship with your College or University, or your grade in any class. [JRM10] If you do participate you may have your data withdrawn from the study at any time.[JRM11]
If you have any questions concerning rights as a research participant, contact the Institutional Review Board by sending an email to or calling 334-808-6294.[JRM12]
If you have questions about this study contact Dr. Bob Apples at (334) 670-1122 or send him an email at .[JRM13]
Please sign and return this form if you agree to participate. You will be given a copy of this form to keep.
Signature______Date______
Printed Name: ______
[JRM1]The Readability Level of the document was checked with Microsoft Word and is 11.7 on the Flesch-Kincaid scale, appropriate for college students.
[JRM2]Statement identifying the researchers and their affiliation with TROY
[JRM3]Statement that the study involves research
[JRM4]Explanation of the purposes of the research
[JRM5]The expected duration of the subject's participation
[JRM6]A description of the procedures to be followed
[JRM7]A description of any reasonably foreseeable risks or discomforts to the subject
[JRM8]A description of any benefits to the subject or to others which may reasonably be expected from the research
[JRM9]A statement describing the extent, if any, to which confidentiality of records identifying the subject will be maintained
[JRM10]A statement that participation is voluntary, refusal to participate will involve no penalty or loss of benefits to which the subject is otherwise entitled, and the subject may discontinue participation at any time without penalty or loss of benefits, to which the subject is otherwise entitled
[JRM11]A statement that their data may be withdrawn from the study at any time.
[JRM12]Required statement
[JRM13]An explanation of whom to contact for answers to pertinent questions about the research.