General Template for Informed Conset

The template should be modified as needed to fit the specifics of the study

Title of Study

You are invited to be in a research study on . . . You were selected as a possible participant because of . . . Please read this form and ask any questions you may have before agreeing to be in the study. Please understand that when researchers involve people in their research, we are required to tell you what your rights are as "a subject in a research study," as well as what will be done with the information collected and whether your name will appear anywhere, any potential risks involved from such participation, and who you can contact with your questions and any complaints. We must also document that we have provided you with this information before you decide whether or not you choose to participate. This study is being conducted by Name, Affiliation as part of . . .

The purpose of this study is to . . .

If you agree to be in this study, I will ask you to do the following: . . . . Participation will take [indicate the amount of time, or range of times.]

• Explanation of the method of insuring anonymity/confidentiality. Conditions under which identifiable data might be shared.
• Describe the benefits to the participant and/or society to being in the study.
• Describe the risks to the participant of being in the study. Indicate the methods for reducing those risks.
• Indicate the participant's right to decline to be in the study, and the consequences of declining to participate. Indicate the participant's right to withdraw from the study after beginning it and the consequences of withdrawing.
• Provide contact information for questions and complaints. (Provide the name and contact information for the researcher, the advisor for student research, and the Institutional Review Board Office.)

A copy of this form is provided for your use.

Statement of consent by the participant (see samples), verification that the participant is 18-years-old or older, and, possibly, a signature.