Informed Consent Form (sample) - Illinois

Informed Consent Form (sample)
Illinois State University
Department of Psychology (2012)
Informed Consent for Participants
Study Name:
Principal Investigator:
Faculty Supervisor:
_________________
_________________
_________________
PLEASE READ THIS DOCUMENT CAREFULLY. YOUR SIGNATURE IS REQUIRED FOR
PARTICIPATION. YOU MUST BE AT LEAST 18 YEARS OF AGE TO GIVE YOUR CONSENT TO
PARTICIPATE IN RESEARCH. IF YOU DESIRE A COPY OF THIS CONSENT FORM, YOU MAY
REQUEST ONE AND WE WILL PROVIDE IT.
The policy of the Department of Psychology is that all research participation in the Department is
voluntary, and you have the right to withdraw at any time, without prejudice, should you object to
the nature of the research. You are entitled to ask questions and to receive an explanation after
your participation.
Description of the Study:
This is a ____ session study in which a number of different kinds of psychological tests and
measures are being evaluated. To do this, we will ask you to do the following: (include a brief
description of the kinds of activities, e.g. "measures of attitudes, feelings, knowledge and skills.")
Nature of Participation:
You will participate in ____ sessions. In the (first) session you will: (describe second session, if
applicable)
Purpose of the Study:
To evaluate several psychological tests and measures, and the possible relations between them.
This means we want to find out some general information about the usefulness of (your variable
inserted here) and how people react and behave. We are only interested in an evaluation of these
variables, and how they are related to one another. We are NOT interested in any specific
individual.
Possible Risks: (e.g., for a questionnaire study...)
a) When (filling out questionnaires,) you may (come across a question or answer choice) that you
find unpleasant, upsetting, or otherwise objectionable. For instance, (a few of the questions may
cause you to think about negative emotional states.)
b) You may feel that you have performed poorly on a test. For many of the activities, tests and
questionnaires we are evaluating, there is no right or wrong answers. However, for some activities,
it is to be expected that some people will do better than others on some of the tests. We
encourage you to discuss this with the test administrator during the debriefing period, when all
procedures have finished.
c) You will be asked to provide confidential information about yourself.
Possible Benefits:
a) When your participation is complete, you will be given an opportunity to learn about this
research, which may be useful to you in your course or in understanding yourself and others.
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