STANDARD CONSENT
FORM FORMAT
HUMAN ANATOMY AND
PHYSIOLOGY
BIOLOGY DEPARTMENT
CONSENT TO BE A RESEARCH
SUBJECT
Project title
A. PURPOSE
AND BACKGROUND
Who is conducting
the stufy? What is it about? Why are you asking this subject to participate?
B. PROCEDURES
If you agree to be in the study, the following will occur:
Explain the
procedure in detail. Use ‘You will’ language. Include how long the study will
take and how many people are involved in it.
C. RISKS/DISCOMFORTS
List any
discomfort you can foresee from any procedures in this study. What can the
subject do if s/he feels discomfort? Make sure to tell them they can cease
participation at any time.
Confidentiality:
How will
the subject’s confidentiality be assured? Will data be kept with names on it?
Will data be discarded? Will data be coded by number instead of name and if so
will the key telling which number means which name be kept or discarded?
D. BENEFITS
Explain what benefit the individual
may get. Will their data be available to them? Will the results of the
experiment be made available to them? Will anybody else benefit from the data?
E. QUESTIONS
You have
talked to the person who signed below about this study and have had your
questions answered. If you have further
questions, you may call him/her at your
phone number
If you
have any comments or concerns about participation in this study, you should
first talk with the researchers. If for
some reason you do not wish to do this, you may contact the Biology Department
at
F. CONSENT
You will be given a copy of this consent
form to keep.
PARTICIPATION IN RESEARCH IS
VOLUNTARY. You are free to decline to be
in this study, or to withdraw from it at any point.
If you agree to participate you should
sign below.
Date Signature
of Study Participant
Date Signature
of Person Obtaining Consent