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Sample Informed Consent Form

The research in which you are about to participate will ask you to answer questions about perceived attractiveness, health, mate selection, and some general questions about general health-related issues and sexual behavior. The study will also ask that you take and provide some simple body measurements.

The procedure in the study is very simple, and participation will not take long. First you will receive instructions and then view and respond to items presented on a computer screen. The instructions should take about 5 minutes, and it should take less than 20 minutes to respond to the computer-presented items. After this, you will be taken to private rooms and asked to take and provide some simple body measurements; this should take less than 5 minutes.

 [Note: This section, which identifies the project as research, describes the nature of the study and procedures, and informs about time commitment, may be more or less detailed, depending on what you are studying. Sometimes you can tell participants exactly what you are studying and exactly how they will be tested. In other cases, you will just give participants some general information about what you are studying. As a general principle you should provide as much relevant information as possible, without compromising the research]
 
As a volunteer participant in research at DePauw University, you should understand that the following rights and conditions apply.

  • Your participation is voluntary, and you may withdraw my participation at any time without penalty.

  • At the conclusion of the experimental session, the experimenters will provide their phone numbers and email addresses and the phone number and email address of the faculty sponsor (these are also shown below). This is to enable you to contact someone should questions or complaints arise.

  • After Month XX, YEAR you may contact one of the following to receive a full description of the nature, purpose and results of this study:

Some Student 
someaddress@depauw.edu    phone#          
Faculty Name facultyemail@depauw.edu
faculty office phone



 [Note: You may choose to debrief participants immediately following the experimental session, arrange a later time for a group debriefing, or arrange a time after which they may contact you. If you use failure, humiliation, or strong deception, you must provide at least a partial debriefing after the session.]

[Note: For the two items just above, the specific manner of presentation of student/faculty researcher contact information is not crucial. What is important is that you provide participants with some form of easy to use contact information that contains your name(s), phone numbers, and email addresses.]

  • The results of the study will be confidential and anonymous. The data will not be recorded or reported in any manner that could reveal individual identity.  No one, not even the researchers will be able to link your name with your responses.  [Note: In this example, the study was able to assure both confidentiality and anonymity. In some studies only assurances about confidentiality may be possible. In rare cases, participants may be asked to give permission for their names to be used; if so this must be made clear in the consent form.]

  • This experiment has been approved by the DePauw Institutional Review Board to insure that the study conforms to ethical principles in the conduct of research with human subjects.

As a volunteer for this study, I, the undersigned, have read and understood the conditions and rights listed above.

NAME (PRINT):_____________________________________
DATE:_____________________________________________
SIGNATURE:________________________________________

If you are receiving extra credit in a course for participating in this study, please put the course number and the professor's name below.

Course:  ______________________________________

Professor's Name:  ________________________________________