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Consent Form Sample #1 for Participation of Human Subjects in Research*

Project Title: Social Influence in Group Decisions

Researcher: Jane A. Doe, Dept. of Psychology, Iona College, 914-633-xxxx,

Description: The purpose of this experiment is to examine the social interaction patterns that develop within small groups. If you volunteer for this research study, you will be asked to participate in a series of group discussions and decisions. Groups will vary from 3 to 9 persons and the topics discussed will relate to issues of common concern to young adults and college students. All other subjects in the study will be fellow students completing the research requirement for their psychology course. The topics are neither embarrassing nor intended to be upsetting. You will first be asked to complete a questionnaire and then will discuss one to six of the topics related to items on the questionnaire with other group members. You may be asked to attempt to reach total agreement among group members on the topics. A second response will then be requested to each question discussed. The total time for your participation will be one hour.

The results of each individual's participation will be strictly confidential. The results of your participation will be recorded by group only. No names or individual identifying information will be maintained. With the exception of the researchers involved in running this study, nobody will be allowed to see or discuss any of the individual responses. Your responses will be combined with many others and reported in group form in a professional journal article.

The risks to you are minimal though you may encounter other individuals attempting to change your mind on some issues during the group discussions. Though all subjects will be asked to keep their comments constructive, the researchers are trained to step in to protect individuals from hostile or inappropriate comments made during discussions. The discussions will be discontinued if any of the group members cannot refrain from inappropriate remarks to others.

The overall nature of the study will be explained as soon as you have completed your session. A summary report and explanation of the results will be made available to you when the study is completed by date if you so request.

Authorization: I have read the above and understand the nature of this study and agree to participate. I understand that by agreeing to participate in this study I have not waived any legal or human rights. I also understand that I have the right to refuse to participate and that my right to withdraw from participation at any time during the study will be respected with no coercion or prejudice. I attest that I am 18 years of age or older.

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

Dr. Michael Jordan
Provost's Office
Telephone: 914-633-2602

This research project has been approved by the Iona College Institutional Review Board, Protocol Number XYZ.

I have read the above information and willingly consent to participate in this study. I attest that I am 18 years of age or older.


Participant signature


Participants should be given a copy of this form for their own records.

* This template is adapted from the University of Wisconsin-Superior and the University of Minnesota Institutional Review Board Forms.