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Informed Consent

PLEASE READ THIS DOCUMENT CAREFULLY. CLICK TO CONTINUE BELOW ONLY IF YOU AGREE TO PARTICIPATE AND YOU FULLY UNDERSTAND YOUR RIGHTS. YOU MUST BE 18 YEARS OF AGE TO GIVE YOUR CONSENT TO PARTICIPATE IN RESEARCH. FOR THIS PROJECT, YOU MUST BE 18 YEARS OF AGE TO PARTICIPATE. IF YOU DESIRE A COPY OF THIS CONSENT FORM, YOU MAY PRINT THIS FORM.

The policy of the Department of DEPARTMENT NAME HERE at Illinois State University 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. Your responses are confidential. Any report of the data collected will be in summary form, without identifying individuals. You are entitled to ask questions and to receive an explanation after your participation.
If you have concerns about your participation in this study, you may contact:

Dr. NAME HERE Phone: (309) 438-PHONE HERE

Description of the Study:

This is a 1 session study in which a number of different kinds of measures are being evaluated.

To do this, we will ask you to do the following:

Nature of Participation:

INFO ON WHAT PARTICIPANTS HAVE TO DO HERE.

Purpose of the Study:

To evaluate several WHAT SCALES ETC YOUR ARE USING HERE measures, and the possible relations between them. This means we want to find out some general information about the usefulness of the questionnaires for helping us understand WHAT YOU ARE TRYING TO MEASURE HERE. We are only interested in an evaluation of these questionnaires, and how they are related to one another. We are NOT interested in any specific individual.

Possible Risks:

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 will be asked to provide private information about yourself.

Possible Benefits:

a) As a token of appreciation, and to compensate you for the time you spend on the questionnaires, you will be given an opportunity to enroll in a lottery in which you may win a gift certificate. PRIZES HERE IF USING

b) When your participation is complete, you will be given an opportunity to learn about this research, which may be useful to you in understanding yourself and others.

c) You will have an opportunity to contribute to AREA OF STUDY HERE by participating in this research. In particular, we hope our results will be helpful to health care professionals who work with PARTICIPANTS LIKE YOU ARE USING HERE.

d) You will have an opportunity to sign up to receive information of interest to expectant and new mothers. You will be free to choose not to receive this information.

Confidentiality:

INDICATE IF IT IS CONFIDENTIAL, ANONYMOUS, or PRIVATE HERE (see example) Your questionnaire responses will be kept private. All data will be kept secured, in accord with the standards of the University, Federal regulations, and the American Psychological Association. No one will be able to know which are your questionnaire responses. Finally, remember that it is no individual person's responses that interest us; we are studying the usefulness of the tests in question for people in general.

Opportunities to Question:

  • Any technical questions about this research may be directed to the Principal Investigator, Dr. NAME HERE, Professor of DEPARTMENT HERE, (309) 438-PHONE HERE
  • Any questions regarding your rights as a research participant or research-related injuries may be directed to Dr. Joseph Casto, Office of Research, Ethics, and Compliance, (309) 438-8451.

Opportunities to Withdraw at will:

If you decide now or at any point to withdraw this consent or stop participating, you are free to do so at no penalty to yourself. You are free to skip specific questions and continue participating at no penalty.

Opportunities to be Informed of Results:

In all likelihood, the results will be fully available around: DATE HERE. Preliminary results will be available earlier. If you wish to be told the results of this research, please contact:

Principal Investigator: Dr. NAME HERE, (309) 438-PHONE HERE

There is a chance that the results from this study will be published in a scientific AREA HERE journal, which would be available in many libraries. In such an article, participants would be identified in general terms as PARTICPANT TYPE HERE.

I have read the statements above, understand the same, and voluntarily participate in this survey. I further acknowledge that I can print a copy of this consent form for my records if I so desire.
(By clicking yes, you are also stating that you are 18 years of age or older.)

LINK "YES" TO SURVEY DEPLOY LINK

Yes
No (I am not 18 or I choose not to participate)