Melissa Dalipsingh

11/27/05

PSY-452-0500

Dr. Mark

SAMPLEINFORMED CONSENT FORM

INTRODUCTION: Anoverview of the procedures for the study together with an outlay ofmy rights as a participant have been provided below. In harmony withthe regulations and standards of [institution], I undertake to perusethe details with great care. My signature below will evidence myconsent to the terms and conditions.

PURPOSE: Thepurpose of this research is [give a brief description of studypurpose here].

DURATION ANDLOCATION OF STUDY: If I consent to participate, my involvement willproceed for [estimate time] at [venue].

PROCEDURES:During this study, I will be asked to [insert brief description ofwhat the participant will do].

POTENTIAL RISKS:[state any risks that are either anticipated or known]

CONFIDENTIALITY:I recognize that all the data gathered during this project will besealed until a disclosure is demanded by superior law. Personalidentifying information will be sealed.

COMPENSATION FORPARTICIPATION: I am entitled to [insert reimbursement] for myenrolment to participate in this study.

RIGHT TO DESISTOR WITHDRAW: I understand that my participation is voluntary. Iwill incur no retribution in form of a penalty if I so choose todiscontinue my participation. My compensation will accrue to meregardless of the duration of my participation. I understand that Iwill neither be privy nor complicit to all the details concerning thestudy project.

OFFER TO ANSWERQUESTIONS: I may reach out to the researcher [name] if I have anyfurther questions concerning the project.

*I HEREBY AFFIRMTHAT I AM AN ADULT BEYOND 18 YEARS OLD, HENCE MY PARTICIPATION ISVOLUNTARY.

SIGNATURE OFPARTICIPANT DATE

AUTHORIZINGPERSON

I confirm that Iallowed the participant time to read this consent form and haveanswered any questions that have been raised.

RESEARCHER`SSIGNATURE DATE

SAMPLEDEBRIEFING FORM

Thank you foryour participation! We hope the experience was as entertaining as itwas insightful. This form avails background information about ourresearch to educate you on our motivations for conducting this study.

You have recentlypartaken in a study research project under the tutelage of [name ofthe researcher and official contact information].

As customary, thestudy team considers your participation as voluntary. If you sodecide as to recant after considering this form, all your files, andconfidential information will be discarded without imposing any finesor penalties.

Due to theongoing nature of the research, we request that you uphold thestrictest form of privacy and confidentiality. Otherwise, we riskcontaminating our study by interfering with the data pools.

If any questionsarise, please address them to [name of the researcher and contactinformation]

References

Davidson College.(2015). Retrieved from:http://www.davidson.edu/offices/grants-and-contracts/human-subjects-irb/informed-consent/sample-consent-and-debriefing-forms