ࡱ> :<9_ Ybjbj 4.h1bh1bG VVVVVjjj8Ljkmmmmmm$D!\VVVcccFVVkckccc]_MFcW0c!!c!Vccc! B : [Adapt this form to your proposed interview research project] Sample Consent Form to Participate in Research at 91ɬ I have been asked to participate in a research study conducted by [name(s) of researcher(s) and email(s)phone number(s) can be added if researchers prefer to use that method], of 91ɬ. INTRODUCTION: Below is a description of the research procedures and an explanation of my rights as a research participant. In accordance with the policies of 91ɬ, I have been asked to read this information carefully. If I agree to participate, I will sign in the space provided to indicate that I have read and understood the information furnished on this consent form. I am entitled to and will receive a signed copy of this form. PURPOSE: The purpose of this research is [give brief description of study purpose here]. POTENTIAL RISKS AND DISCOMFORTS: [describe any that are known] OR I understand there are no known or anticipated risks associated with participation in this study. BENEFITS: A benefit to me of participating in this study is an increased understanding of how research is conducted. [Include additional benefits, if any. PLEASE NOTE that course credit, money, gift cards, etc. are part of COMPENSATION instead of a benefit so such information belongs below.] RIGHT TO REFUSE OR WITHDRAW: I understand that my participation is voluntary. I may refuse to participate or discontinue my participation at any time; there will be no penalty for doing so. Some details of this project may not be made known to me until my session is completed. I realize at the completion of the session that I have the option of withholding the responses I have provided from subsequent analysis. I also understand that the researcher has the right to withdraw me from participation in the study at any time. DURATION AND LOCATION OF STUDY: If I agree to participate in this study, my participation will last for approximately [duration estimate] and will take place at [location]. PROCEDURES: During this study, I will be asked to [insert brief description of what the participant will do]. CONFIDENTIALITY: I understand the data collected in this study will be kept confidential unless disclosure is required by law. [Insert specifics such as: Specifically, the researcher will use a code number instead of my name on my data sheet. The code number and names will be kept separately from each other in a secure location.] After four years all personally identifying information will be destroyed. [If this an ANONYMOUS study, explain that.] COMPENSATION FOR PARTICIPATION: I will receive [insert description of compensation or no compensation] for my participation in this study. [If applicable, indicate whether or not receipt of compensation is dependent upon completing the study.] OFFER TO ANSWER QUESTIONS: If I have any questions about this study, I may call the researcher, [insert name of researcher and/or faculty member supervising this research with email address and/or phone]. If I have questions about my rights as a participant, I may contact the 91ɬ IRB at  HYPERLINK "mailto:hsirb@davidson.edu" hsirb@davidson.edu or 704-894-2181. *I CERTIFY THAT I AM AT LEAST 18 YEARS OLD AND I AGREE TO PARTICIPATE IN THIS RESEARCH PROJECT. PARTICIPANT'S SIGNATURE DATE PERSON OBTAINING CONSENT: I have allowed the individual named above the time to read this consent form and have answered any questions that have been asked. I will provide the participant with a copy of this consent form. 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