Consent Form Sample #3 for Participation of Human Subjects in Research*

PLEASE DO NOT PUT YOUR NAME ANYWHERE ON THIS SURVEY. There is no need to identify yourself.

You are being asked to complete this survey to help researchers better understand some of the behaviors and attitudes of college students in the Northeast. Many of the questions ask about your plans and activities with respect to career and family. Thus, for some respondents these may be current activities and for others they may require either a look into the past or into the future. Please be as honest with us as possible and answer all questions to the best of your knowledge. You should be able to complete the questionnaire in about 25 minutes.

Once the study is completed, a summary of the results will be made available through the Sociology Department office.

Your participation in this survey is entirely voluntary. By completing this survey you are giving your consent to be involved in the research. If at any point you decide that you do not want to complete the questionnaire, please return it and inform the administrator. Your course grades will not be affected if you decide not to participate.

Please feel free to ask any questions you may have of the person who is giving you this survey, especially if there is a word or phrase you do not understand. Feel free to write in the margins if you feel you need room to express or explain an answer. Please do not complete this survey unless you are 18 years of age or older.

Thank you for your cooperation and the time that you have put into the project.

If you should have concerns about your treatment as a subject in this study, please call, email, or write:

Provost's Office
Telephone: 914-633-2602
E-Mail:tgrimes@iona.edu

This research project has been approved by the Iona College Institutional Review Board, protocol #______.

Again, please do not put your name anywhere on this survey.
Thank you,
Dr. Jane Doe, 914-633-xxxx,E-Mail: jdoe@iona.edu

*Appropriate for questionnaire/survey research, where data are recorded in an anonymous fashion, that does not address sensitive or illegal behaviors, and whose subjects are at least 18 years of age.

Subjects should be given this form for their records.