University of Nebraska Kearney

UNK
UNK
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Sample Adult Consent Form for Non-Therapeutic Research that is Minimal Risk

Write all consent forms using letterhead stationery.  If the consent form is more than one page, provide a place for the subject to initial each page, and write the IRB number at the top of each page.

IRB #120910-5 

Title of the Research Study:  Mood and the Framing Effect:  The Impact of Personal Involvement 

Invitation to Participate 

You are invited to participate in this research study.  The following information is provided in order to help you to make an informed decision whether or not to participate.  If you have any questions, please do not hesitate to ask. 

Basis for Subject Selection 

You are eligible to participate because you are a student in an introductory psychology course at the University of Nebraska at Kearney. 

Purpose of the Study 

The purpose of this study is to explore the effect of mood and situational factors on decision-making. 

Explanation of Procedures 

This study will be conducted in the Department of Psychology in Copeland Hall at UNK-Kearney.  The procedures will take approximately 30 minutes to complete.  You will be asked to complete two questionnaires concerning your mood and the way you have been feeling during the past week, and one questionnaire concerning demographic information such as your age, sex, etc.  You will also be asked to respond to three decision-making problems involving cancer treatment and disease prevention.  Each problem requires you to choose from among two options. 

Potential Risks and Discomforts 

It is possible that some of the questions that ask about your mood and feelings may make you feel stress or discomfort. 

Potential Benefits to Subject 

There are no direct benefits to you as a subject. 

Potential Benefits to Society 

Results obtained from this research may help determine the effects of mood and situational factors on decision-making, which could lead to improved methods of psychological counseling. 

Alternatives to Participation 

If you decide not to participate, you can earn the same amount of credit by writing a very brief report on a selected topic. 

Compensation for Participation 

You will receive research credit in your psychology class. 

Assurance of Confidentiality 

Any information obtained during this study that could identify you will be kept strictly confidential.  The information obtained in this study may be published in scientific journals or presented at scientific meetings, but the data will not contain any identifying information. 

Rights of Research Subjects 

Your rights as a research subject have been explained to you.  If you have any additional questions concerning your rights as a research subject, you may contact the University of Nebraska at Kearney Institutional Review Board (IRB), phone 308-865-8843. 

Voluntary Participation and Withdrawal 

You are free to decide not to participate in this study or to withdraw at any time without adversely affecting your relationship with the investigators or the University of Nebraska.  Your decision will not result in any loss of benefits to which you are otherwise entitled. 

Documentation of Informed Consent 

You are voluntarily making a decision whether or not to participate in this research study.  Your signature certifies that the content and meaning of the information on this consent form have been fully explained to you and that you have decided to participate having read and understood the information presented.  Your signature also certifies that you have had all your questions answered to your satisfaction.  If you think of any questions during this study, please contact the investigators.  You will be given a copy of this consent form to keep. 

_________________________________             __________________________ 
Signature of Subject                                                  Date 

In my judgment, the subject is voluntarily and knowingly giving informed consent and possesses the legal capacity to give informed consent to participate in this research study. 

_________________________________              __________________________ 
Signature of Investigator                                              Date 

Identification of Investigators 

     Principal Investigator 

          Cheryl A. Jones, Ph.D.                               Off:  865-1111                       H:  234-3337 

     Secondary Investigator 

          Frances H. Jones, M.A.                              Off:  865-2222                       H:  440-4444 

 

 Approved 12/15/10