ࡱ> jli_ bjbjCC 42)D\)D\8@@@@@TTT8DTw2wwwwwww.y{w@w@@wF@@wwPtRww0w~|mL~|~|@^www~|> : Sample consent form [modify it and sections in [brackets] as appropriate to your purpose] INFORMED CONSENT You are being invited to participate in a research study, which the 88 Institutional Review Board (IRB) has reviewed and approved for conduct by the investigators named here. This form is designed to provide you - as a human subject/participant - with information about this study. The investigator or his/her representative will describe this study to you and answer any of your questions. You are entitled to an Experimental Research Subjects Bill of Rights and a copy of this form. If you have any questions about your rights as a subject or participant, complaints about the informed consent process of this research study, or experience an adverse event (something goes wrong), please contact the Research Compliance Office within 88ޒs Office of Research at 909.869.4215. More information is available at the IRB website,  HYPERLINK "http://www.cpp.edu/~research/irb/index.shtml" http://www.cpp.edu/~research/irb/index.shtml [Your IRB study title] Primary Investigator: [your name] Faculty Advisor: [as applicable] IRB protocol # [once assigned] Voluntary Status: You have met the requirements for enrollment as a volunteer in a research study conducted by the researchers listed above. You are now being invited to participate in this study. Before you can make your decision, you will need to know what the study is about, the possible risks and benefits of being in this study, and what you will have to do in this study. The research team will discuss with you the details, and they will provide you this consent form to read. You may also decide to discuss it with your family and/or friends. Some of the language may be difficult to understand and if this is the case, please ask the researcher and/or the research team for an explanation. If you decide to participate, you will be asked to sign this form. Your participation is voluntary. You may withdraw any time without penalty and there will be no loss of any benefits to which you are entitled. Purpose: The Primary Investigator states: In my [under]graduate program at 88, I am developing a project on [fill in the details]. Procedures: You will be asked a few questions regarding [describe the methods of the study pertaining to the subject as appropriate]. After the raw data have been collected, all names will be removed. Your name will be assigned a code number. Only the code number will be left as identifiers. Commitment and Compensation: Your total participation in the study will take [###] session(s), which will last approximately [###] minutes. You will not receive financial compensation for participation in the study. [Alternatively, describe the kind of compensation.] Possible Risks and Benefits: It is expected that participation in this study will provide you with no more than minimal risk or discomfort, which means that you should not experience any more difficulty than what would occur in your normal daily life. However, there is always the chance of an unexpected risk. The foreseeable risks in this study include an accidental disclosure of your private information, or discomfort by answering questions that are embarrassing. If you feel uncomfortable or distressed, please tell the researcher and he/she will ask you whether you wish to continue. You can withdraw from the study at any time without penalty. You will not receive any direct benefits from participating in this study. However, your participation is intended to add to the knowledge about [list expected outcomes in the study]. It may also benefit other people with similar concerns. Confidentiality and Consent: The investigator and staff involved with the study will not reveal the personal information which they collect about you. Any information that is obtained in connection with this study -- and that can be identified with you -- will remain private and will be disclosed only with your permission or as required by law. Your identity will be kept strictly confidential by removing your name and all identifiers. Once the project is completed, all interview materials will be destroyed. Do be aware, that the results, in either an anonymous or a summarized format, will likely be published or presented at conferences. New Information: During the course of this study, the investigators may discover information that could be important to you. They will notify you as soon as possible when such information becomes available. Consent: I consent to participate in the study. I understand that my participation in this study is entirely voluntary and that I may refuse to participate or withdraw from the study at any time without penalty. I have received a copy of this consent form for my records. _______________________________________________________________ Printed name of participant Signature Date _______________________________________________ Signature of primary investigator Date:     Office of Research Compliance-March 2016 :YZjkl * + - ȸȤsbMbM:Mb$h>oh>o0JCJOJQJ^JaJ)jh>oh>oCJOJQJU^JaJ h>oh>oCJOJQJ^JaJ h>oh>oCJOJQJ^JaJ#h>oh35CJOJQJ^JaJh>oh0?5OJQJ^J&h>oh35>*CJ OJQJ^JaJ h>oh5>*OJQJ^Jh>ohN:5>*OJQJ^J&h>oh5>*CJOJQJ^JaJ&h>oh35>*CJ(OJQJ^JaJ(Zkl- . 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