ࡱ> >@== nbjbj.. 4(LhLh]XX:::NNNNjNtkmmmmmm$`t:"3"8:kk"@RW0O4:4XX : HOOD COLLEGE INFORMED CONSENT FORM Note to Researcher (remove note from finished Consent Form): The bolded headings must be included in your consent form. The bolded text is suggested language and the bracketed information includes suggestions for information inclusion. Delete the bracketed information from your finished Consent Form. Remember to keep the language simple and your explanations concise. [Insert title of study] Consent Form 1. INTRODUCTION You are invited to be a participant in a research study about [insert general statement about study]. You were selected as a possible participant because [explain how subject was identified]. We ask that you read this document and ask any questions you may have before agreeing to be in the study. We require that participants in this study be at least 18 years old. The study is being conducted by [indicate College affiliation]. 2. BACKGROUND AND PURPOSE OF THE STUDY The purpose of this study is [explain research questions and purpose in lay language. Include some brief background information on research that has been done in the area]. 3. DURATION The length of time you will be involved with this study is [indicate the time that participants can be expected to be in the study]. 4. PROCEDURES If you agree to be in this study, we will ask you to do the following things: [Explain tasks and procedures from subjects point of view. What will he or she be expected to do? Be sure to explain how groups will be assigned (if applicable) and for survey research, indicate that not all questions have to be answered. Be sure all procedures are explained and terms defined at an eighth-grade level.] 5. RISKS/BENEFITS This study has the following risks: [Honestly explain risks, hazards, or discomforts, including the likelihood of any identified risks]. The benefits of participation are: [Describe any benefits to the subject or others that could be reasonably expected from the research. Describe any payment/inducement that the subject may receive]. 6. CONFIDENTIALITY The records of this study will be kept private. [Describe how records will be stored and who will have access to study records]. In any sort of report that is published or presentation that is given, we will not include any information that will make it possible to identify a participant. 7. VOLUNTARY NATURE OF THE STUDY Your participation in this study is completely voluntary. Your decision whether or not to participate will not affect your current or future relations with Hood College or any of its representatives. If you decide to participate in this study, you are free to withdraw from the study at any time without affecting those relationships. [Include information on when and how the participant can withdraw from the study. Indicate that the participants responses will be destroyed and will not be included in the study results]. 8. CONTACTS AND QUESTIONS The researcher(s) conducting this study is (are) [insert names of all investigators]. You may ask any questions you have right now. If you have questions later, you may contact the researchers at [include phone number of principal investigator]. If you have questions or concerns regarding this study and would like to speak with someone other than the researcher(s), you may contact Dr. Molly Moreland, Institutional Review Board Chair, Hood College, 401 Rosemont Ave., Frederick, MD 21701, moreland@hood.edu. 9. COMPENSATION [This heading only needed for studies that have a risk of injury, such as physically invasive procedures.] In the event that this research activity results in an injury, treatment will be available, including first aid, emergency treatment, and follow-up care as needed. Care for such injuries will be billed in the ordinary manner, to you or your insurance company. [Indicate any additional information regarding sponsored research and the sponsors responsibility for compensation related to injuries.] 10. STATEMENT OF CONSENT You will be given a copy of this form to keep for your records. The procedures of this study have been explained to me and my questions have been addressed. The information that I provide is confidential and will be used for research purposes only. I am at least eighteen years old. I understand that my participation is voluntary and that I may withdraw anytime without penalty. If I have any concerns about my experience in this study (e.g., that I was treated unfairly or felt unnecessarily threatened), I may contact the Chair of the Institutional Review Board or the Chair of the sponsoring department of this research regarding my concerns. Participant signature________________________________________Date________________ Signature of Parent/Guardian [if applicable] ______________________________Date________________ Signature of Person Obtaining Consent ______________________________Date________________ IRB Use Only: $%&  ? r  K j b c f o p   R 56WC7:;>[\]h/hP%Y5\ hP%Y5\ huv5\h3 h35\ h^5\ jho5U\mHnHuK$%& b c o p   56$a$6:;\]noHI 0^`0gd^]mnor  O!EQz{̽~~w hz5\ h8H5\h^h^5\ h|`5\ h^5\ h'"5\ h~K5\ h zf5\ h35\h3h%h35B*CJphh%5B*CJphh%B*CJph h%CJ h'QCJ h~KCJ h3CJ h zfCJ.HI)*\]iklmnho h|`5\ huv5\ h35\ h3CJh3!)*]klmn21h:p#/ =!"#$% x2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p(8HX`~8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_HmH nH sH tH @`@ #NormalCJ_HaJmH sH tH F@F # Heading 1$@&^`0 5CJ\>@> # Heading 2$@& 5CJ\DA D Default Paragraph FontRiR 0 Table Normal4 l4a (k ( 0No List 6U 6 # Hyperlink >*B*ph0>0 #Titlea$5\8B@8 # Body Text 5CJ\PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vj\{cp/IDg6wZ0s=Dĵw %;r,qlEآyDQ"Q,=c8B,!gxMD&铁M./SAe^QשF½|SˌDإbj|E7C<bʼNpr8fnߧFrI.{1fVԅ$21(t}kJV1/ ÚQL×07#]fVIhcMZ6/Hߏ bW`Gv Ts'BCt!LQ#JxݴyJ] C:= ċ(tRQ;^e1/-/A_Y)^6(p[_&N}njzb\->;nVb*.7p]M|MMM# ud9c47=iV7̪~㦓ødfÕ 5j z'^9J{rJЃ3Ax| FU9…i3Q/B)LʾRPx)04N O'> agYeHj*kblC=hPW!alfpX OAXl:XVZbr Zy4Sw3?WӊhPxzSq]y nn?(]n6n8@(  P   "? B S  ?n&t{ ]loajW[ d  ]lo3333 ! z HI\o ! z HI\o" 2Ta "'"Y&$m0.I4L98H~KP%Y|` zfoDwzv'Qw+3 C^/aQ4I#nOU%uv]_@  n@UnknownG.[x Times New Roman5Symbol3. .[x ArialC.,.{$ Calibri Light7..{$ CalibriA$BCambria Math 1hGm'f3Fz #z #!0TTC#@P?'~K2!xxWf3 Skidmore CollegenewuserJolene Sanders Oh+'0  0 < H T`hpxSkidmore CollegenewuserNormalJolene Sanders3Microsoft Office Word@G@t5@i@~z ՜.+,0 hp  Skidmore College# T Skidmore College Title  !"#$%&'()*+,./012346789:;<?Root Entry FƈAData 1TableWordDocument4(SummaryInformation(-DocumentSummaryInformation85CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q