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Indiana University Northwest

Human Subjects Committee

IUN Exhibit B2

Below is a sample of Students as Subjects Consent Statement.

To Be Signed After Grades are Posted
SAMPLE CONSENT STATEMENT
Indiana University Northwest
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 of 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, Raintree 139, Indiana University Northwest, Gary IN, 219 980-6680.

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