SAMPLES OF FORMS OF CONSENT

These samples are provided to help you compose your own consent procedure. Decide which form of consent you will need, and then use the appropriate form(s) to make your own. Place the specific information for your project in the appropriate places, as indicated. Once you have written your own version, read it to make sure all the necessary information is there, that there are no mistakes, spelling or grammatical errors, and that it is not ambiguous or otherwise confusing. Below is the Bill of Rights that reflects the philosophy of informed consent and may be included in your consent form.

EXPERIMENTAL SUBJECTíS BILL OF RIGHTS

The rights below are the rights of every person who is asked to be in a study. In participating as a human subject I have the following rights:

The Social Sciences Experiment Consent Form is the most common type of consent form used at Western Oregon University. If you are planning to conduct educational, psychological, or other types of behavioral research then this is probably the type of consent form you should use.

SAMPLE SOCIAL SCIENCES EXPERIMENT CONSENT FORM

(Used With Permission)

Western Oregon University and the Department of _____ support the practice of protecting research participants' rights. Accordingly, this project was reviewed and approved by the WOU Institutional Review Board. The information in this consent form is provided so that you can decide whether you wish to participate in our study. It is important that you understand that your participation is considered voluntary. This means that even if you agree to participate you are free to withdraw from the experiment at any time, without penalty.

This study is an investigation into some of the basic processes we use to understand text. For this study, you will complete two reading tasks: a) a sentence judgment task and b) a reading comprehension task. For the sentence judgment task you will be asked to judge whether sets of sentences are grammatical and your memory for some of the words in the sentences will be tested. For the reading comprehension task, you will read brief passages from a computer screen and answer some questions that test your understanding of the passages.

In addition, you will be videotaped while you perform the task on the computer, so that we can observe you as you do the task. These videotapes will be viewed only by project personnel, who will transcribe them, and then the tapes will be placed in a locked file cabinet in my office until the following date: __________, when they will be destroyed. During this period only the principal investigator will have access to these tapes.

This experiment poses no known risks to your health and your name will not be associated with the findings. For participation in this research project, you will receive $5 at the end of the session. Also, upon completion of your participation in this study you will be provided with a brief explanation of the question this study addresses. If you have any questions not addressed by this consent form, please do not hesitate to ask. You will receive a copy of this form, which you should keep for your records.

We thank you for your time.
 
 
 
 
 
 
 
 

Researcherís Signature

(researcherís name, office and phone number)
 
 
 
 

CONSENT STATEMENT:

I have read the above comments and agree to participate in this experiment. I give my permission to be videotaped, under the terms outlined above. I understand that if I have any questions or concerns regarding this project I can contact the investigator at the above location or the WOU Institutional Review Board at (503) 838-8271
 
 
 
 
 
 
 
 

________________________________ _______________

(Participantís signature) (date)
 
 




SAMPLE COVER LETTER (Used With Permission)

Survey of Visitors at Gifford Pinchot National Forest

Dear __________:

In recent years, management policies of federal forest lands in the Pacific Northwest have changed to reflect social as well as ecosystem objectives. Adaptive management areas (AMA) have been formed for that purpose in ten locations throughout Washington, Oregon and Northern California.

The purpose of this survey is to learn more about recreational activities within Cispus AMA, which is located in the Gifford Pinchot National Forest. The results will be used to assist in the development of recreational policies. This project has been funded by __________ and is being conducted by __________ in the department of _________ at Western Oregon University. Your name was selected from a list of people who visited the CISPUS AMA within the last year. Participation in this survey is entirely voluntary, however, in order to gather a fair impression of the value of recreational uses, it is important that as many people as possible respond to the survey. Your answers will be kept strictly confidential. The identification number at the bottom of the page is only for mailing purposes; no record of these numbers will be retained once the survey is completed and returned. If you would like a copy of the results, please return with the completed survey a note with your address on a separate slip of paper, marked ëCOPY OF THE RESULTS REQUESTED." Please do not record this information on the questionnaire itself. Thank you for your time and effort.

If you have any questions, concerns or complaints with this research, feel free to contact us at this number (_______________) or you can contact the Western Oregon University Institutional Review Board at (503) 838-8271.

Respectfully,
 
 
 
 
 
 

PI Name, department, address, phone number
 
 




SAMPLE VERBAL CONSENT SCRIPT

Hello, my name is _____, and I am a student/faculty with the Western Oregon University Department of __________. I am collecting data for my research project on (brief description of subject), and Iíd like to ask you for your help by answering a few questions for me regarding (describe subject of questions). Your participation in this survey should take about ___ minutes.

This research has been reviewed and approved by the Institutional Review Board at WOU. If you have any questions or concerns about this research project, you can contact the WOU IRB at (503) 838-8271. These data will be strictly confidential and I will not record your name. Also, your participation is completely voluntary. You are free to not answer any questions you may find objectionable, and may withdraw from my study at any time, just by letting me know you would not like to continue any further.

Are there any questions about my study that I can answer for you at this time? (answer questions). Would you like to participate in my study?