NAME OF STUDY
Note: You are not required to name your study in a way that reveals the hypotheses or other information that could bias your results.
Consent Form
PSYCxxx3-Research Methods {name and number of course, Northwest University
Name or names of investigators
You are invited to participate in a research study conducted by {psychology students in the M.A. at Northwest University; change as necessary}.The study is being conducted as a class requirement for PSYC xxx3, Research Methods and Applications. The purpose of this study is {state your purpose}
If you agree to participate in the study you will {state what will be done, a questionnaire or survey, how long it will take, etc}
There are minimal risks associated with participation. Some individuals may be uncomfortable answering personal questions. {State what is appropriate for your study—other risks, how you will address the risks, any benefits particular to your study. You may not state potential benefits. You can state that their participation will broaden the knowledge of how to….. There is no such thing a study with no risks; if you claim that your study has no risks, it will not be approved by the IRB.}
Participation in this study is voluntary. You may choose not to participate in this study at any time and for any reason. There will not be any negative consequences for you if you refuse to participate. You may refuse to answer any questions asked. All responses are anonymous; (if they are confidential, please state how you will keep the information confidential.therefore it is important that you DO NOT put your name on your response sheet{assuming that responses are given in writing. Modify as appropriate}. You may keep this consent form for your records. By turning in this questionnaire{modify as appropriate}, you are giving permission to use your responses in this research study{see below}.
The results from this study will be presented {state how the results will be used}. All data forms will be destroyed {give date}. (State whether they will receive information about the results if appropriate.)
If you have any questions about this study, contact {List your contact info here with a phone and or email, if more than one student choose one for contact}. If further questions, please contact my/our faculty advisor{name and contact information}.You may also contact the Chair of the Northwest University IRB, Professor Suzanne Barsness, at or 425-889-5763.
Thank you for your consideration of this request.
LIST NAMES Here
Names of all student researchers and one student contact listing.
List name of faculty advisor again
{NOTE: This template is intended for use when no signature is required for participation. This would be the case when anonymous questionnaires are administered and the responses are associated only with groups of participants and not with specific participants. When something other than an anonymous questionnaire is administered, you need to include signature lines for the Researcher, Participant(s), and Witness. If children or other people who cannot consent for themselves are your participants, then re-phrase this Consent Form accordingly so that it states that the person or persons who sign are consenting on behalf of someone else.}