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ResearchParticipantInformationandConsentForm
1. EXPLANATIONOFTHERESEARCHandWHATYOUWILLDO: (Muststateresearch)
Pointstoinclude:
Youarebeingaskedtoparticipateinaresearch studyof
Discusswhat,ifanything,theparticipantshavetodo,notdointhestudy.Describetheprocedureschronologically.
Youmustbe atleast18yearsold toparticipateinthisresearch.
2.YOURRIGHTSTOPARTICIPATE,SAYNO,ORWITHDRAW:
Pointstoinclude:
Participationinthisresearchprojectiscompletelyvoluntary.Youhavetherighttosayno.Youmaychangeyour
mindatanytimeandwithdraw.Youmaychoosenottoanswerspecificquestionsortostopparticipatingatanytime.
Whetheryouchoosetoparticipateornotwill have noaffecton yourgradeorevaluation.
3.COSTSANDCOMPENSATIONFORBEINGINTHESTUDY: (Ifapplicable)
Pointstoinclude:
Discussanycoststotheparticipant.
Discussanycompensation(amount,timing)totheparticipant.
o Youwill be compensated.
o Youwillreceive
Forresearchonstudents,telltheparticipantiftheywillreceivecreditorextracreditincludeamount.
Informstudentsoftheequivalent,nonresearchassignmentwhichmaybedoneinplaceofresearchparticipation.
4.CONTACTINFORMATIONFORQUESTIONSANDCONCERNS: (Investigatorcontactinformation is
necessaryHRPPcontactinfoisNOTrequiredforEXEMPTresearch)
Ifyouhaveconcernsorquestionsaboutthisstudy,suchasscientificissues,howtodoanypartofit,ortoreportaninjury,
pleasecontacttheresearcher(nameandcompletecontactinformation:mailingaddress,emailaddress,phonenumber).
Ifyouhavequestionsorconcernsaboutyourroleandrightsasaresearchparticipant,wouldliketo obtaininformationoroffer
input,orwouldliketoregisteracomplaintaboutthisstudy,youmaycontact,anonymouslyifyouwish,theMichiganState
UniversitysHumanResearchProtectionProgramat5173552180,Fax5174324503,oremail irb@msu.eduorregular
mailat207OldsHall,MSU,EastLansing,MI48824.
5. DOCUMENTATIONOFINFORMEDCONSENT.
AsignatureisnotarequiredelementofconsentforEXEMPTprotocols:
You indicate your voluntary agreement to participate by completing and returning this survey. Or You indicate your
voluntaryagreementtoparticipatebybeginningthisphoneinterview.OrByclickingonthebuttonbelow,youindicateyour
voluntaryagreementtoparticipateinthisonlinesurvey.
OR
Ifyouwouldliketoaskparticipantstosign,pleaseusethestatementbelow:
Yoursignaturebelowmeansthatyouvoluntarily agree toparticipateinthisresearchstudy.
________________________________________ _____________________________
Signature Date

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