EXHIBIT B-2
TO BE SIGNED AFTER GRADES ARE POSTED
SAMPLE CONSENT STATEMENT
Indiana University - Bloomington
INFORMED CONSENT STATEMENT
[Project Title] Study # _____
You are invited to participate in a research study. This study investigates ______________________. The purpose of this study is to ______________ .
INFORMATION
1. The following activities were part of the regular [name of course] curriculum of. [Describe activities, e.g. required writings, tests] If you volunteer for this study, the researchers will review your class activities as part of this study now that grades have been turned in.
2. Your participation in this study requires no additional time with the exception of an audio-taped interview regarding your experiences with _________ lasting no more than _____ hour(s) in length.
3. In signing this consent statement, you agree to give permission for the researchers to use your materials and the audio-tapes for research purposes only. The transcribers will use pseudonyms to protect the identity of the participants. You may preview and make changes to the transcripts before they are analyzed.
BENEFITS
It is anticipated that you will benefit from your participation
in the following ways: _____________.
RISKS
There are no foreseeable risks or discomforts for any of the procedures
to be used in this study.
CONFIDENTIALITY
There are numerous methods that will be used to preserve your
confidentiality. All tapes will be stored in a locked metal
cabinet in the primary researcher's office. The transcriber
will preserve confidentiality by assigning a pseudonym to all
participants. The analysis of the data will focus on group
patterns that will be described in aggregate terms. Direct
quotes will be used only for illustrative purposes. The
tapes will be destroyed _______.
CONTACT
If you have any questions about this study or its procedures,
you may contact the primary researcher, _____________ at ____________________.
If you feel you have not been treated according to the descriptions in this form, or that your rights as a participant have not been honored during the course of this project, you may contact the Human Subjects Committee, Indiana University, Carmichael Center L03, 530 E. Kirkwood Ave., Bloomington IN, 47408 (812) 855-3067, or email at iub_hsc@indiana.edu.
PARTICIPATION
Your participation in this study is voluntary; you may decline
to participate without penalty. If you decide to participate,
you may withdraw from the study at any time without penalty and
without loss of benefits to which you are otherwise entitled.
If you withdraw from the study before data collection is completed
your data will be returned to you or destroyed.
CONSENT
I have read this form and received a copy of it. I have
had all my questions answered to my satisfaction. I agree
to take part in this study.
Subject's signature _______________ Date___________
Consent form date XX-XX-XX
