CONSENT TO PARTICIPATE IN RESEARCH
Template – F for DPU Classroom Research Activities
(Use Depaul University Letterhead for all Participants)
This form asks for your consent to participate in a research study. The
study is on the topic of ________________ and is being conducted by ________________
as part of a course research requirement. The general purpose of this research
study is to examine issues related to _______________________________________________________.
You will be asked to ___________________________________________________.
The risks associated with participation in this study are minimal and include
_________________________________. To protect your privacy and increase
the confidentiality of the information that you provide, we will ____________________________________________.
Please be informed that:
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Your participation in this study is fully voluntary. You have a right to
stop participating at any time without any consequences.
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All information that you provide in this study will be kept strictly confidential
and any report of the research will not identify you personally in any
way.
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At the completion of this study, you will be given a thorough explanation
of the purpose and value of this research and why you did what you did
in the study.
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Your participation will take no longer than _____.
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In signing this form you certify that you are 18 years of age or older.
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There is a possibility that you may be mislead temporarily as to the exact
purpose of the tasks that you have been asked to do in this study.
If you have any questions please feel free to ask the researcher. If you
desire information in the future regarding your participation in this study,
please contact the researcher at [investigator's
namd and phone number]. If you have any questions regarding your
rights as a participant in this research study, you may speak to the Coordinator
of the DePaul University Institutional Review Board for the Protection
of Human Research Subjects by calling (773) 325-2593.
Your signature below indicates that you have read the information provided
above and agree to participate in this study.
Date_________ Signature_____________________
Printed Name of Participant ___________________
I hereby certify that the above information was read by the participant
and that requested explanations concerning the study were given.
Date_________ Signature of Researcher ______________________
DPU-IRB approval number __________