Informed Consent – [Title]
You are invited to participate in a study of [what your study does]. The study is being conducted at Westmont College by [student] under the supervision of [supervising professor]. This study was approved by the Westmont's Institutional Review Board for the Protection of Human Subjects Research on [Date of Approval]. The results of the study will be used to learn more about [short subject].
The study will take about [how long?] to complete. Participation will involve [what the respondent will do]. Your involvement is completely voluntary. You may choose not to answer any question during the interview and are free to withdraw from the study at any time. Refusal to answer a question or withdrawal from participation involves no penalty. Your answers are anonymous. [Note, you may have to change this paragraph to better reflect your study].
Although this research does not address the following, I am required to inform you that there are two exceptions to the promise of confidentiality. Any information you reveal concerning suicide, homicide, or child abuse and neglect is required by law to be reported to the proper authorities. In addition, should any information contained in this study be the subject of a court order, Westmont College might not be able to avoid compliance with the order or subpoena.
The benefits of being involved in this study include [benefit]. You may also enjoy the ability to provide information about your own experiences. If you would like a copy of the results of the study, the researcher will be happy to provide one for you. You will, however, receive no compensation for your participation in the project. Potential risks of being involved include [potential risks]. If this occurs, the researcher will arrange for supportive care from staff at Westmont’s health center
If you have any concerns or complaints about how you were treated during the research sessions, please contact [Professor’s contact information] and [IRB Chair’s contact information]
------once signed, cut here abd researcher keeps bottom part------
Please sign below if you understand and agree to participate.
I have read and understood the foregoing descriptions of the study called [Title]. I have asked for and received a satisfactory explanation of any language that I did not fully understand. I agree to participate in this study, and I understand that I may withdraw my consent at any time without penalty. I have received a copy of the consent form.
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Signature Date
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Page 1 3/20/2013