SAMPLE INFORMED CONSENT FORM

 (You may use this form as a guideline for writing the informed consent form.  Your specific consent form should include information pertinent to your specific research project, and may need to be considerably different from this sample.  The sections written in bold are to be filled in by you.)

 My name is (name of person doing project), and I am a (student/professor, etc.) at Union College).  I am inviting you to participate in a research study.  Involvement in the study is voluntary, so you may choose to participate or not.  A description of the study is written below.

 I am interested in learning more about (your research topic.)  You will be asked to (state what the subject will be asked to do.)  This will take approximately (state the expected length of time).   The risks to you of participating in this study are (state the risks to subjects.)  These risks will be minimized by (state the procedures you will use to minimize the risks.)  If you no longer wish to continue, you have the right to withdraw from the study, without penalty, at any time.

 (When appropriate, either or both of the following paragraphs should be included.)

 All information will be kept  (either confidential, in the case where subjects’ identities need to be retained or can be associated with their responses, or anonymous and confidential, in the case where data collection does not allow responses to be connected with a particular subject).

 Even though all aspects of the experiment may not be explained to you beforehand (e.g., the entire purpose of the experiment), during the debriefing session you will be given information about the experiment and have the opportunity to ask questions.

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All of my questions have been answered, and I wish to participate in this research study.

_________________________________________              _________________________

Signature of participant                                                                                     Date

_________________________________________

Print name of participant

_________________________________________              _________________________

Name of investigator                                                                                         Date