informed consent examples

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Appendix D

SAMPLESInformed Consent Form

Dear Research Participant,

You are being asked to participate in a research project I am completing as part of my Sociology of the Family class at Nebraska Wesleyan University. This project explores personal experiences and attitudes about family life. Your signature below gives me and the instructor permission to use the information gathered during the interview for research purposes.

Please be assured that every effort will be made to ensure your confidentiality. Your identifying information will not be in the written paper; instead a pseudonym for you will be used when writing and presenting the paper in class. In addition, the Informed Consent Form will be separated from the completed paper and retained by the instructor for one year in a secure location. After that period of time the forms and any recordings will be destroyed.

While there are no known risks in participating in such research, it is possible to experience some psychological distress if the topic of discussion covers an area that is sensitive to the respondent. In the event that such feelings occur, the respondent is referred to the Community Mental Health Center of Lancaster County, at 402.441.7940 for a listing of mental health counselors in Lancaster County. Expense for such services would be the responsibility of the research participant.

While the expected risks are minimal, there are also no monetary benefits. However, some benefit may accrue to the research participant by having the opportunity to discuss their personal attitudes with the student-researcher.

Your participation in this student research project is fully optional and voluntary, but is greatly appreciated. You are free to withdraw from this study at any time and your withdrawal will in no way affect your relationship with the researcher, the advisor, or Nebraska Wesleyan University.

If you have any questions, comments, or concerns following this interview, please feel free to contact either me or my instructor at the telephone numbers below. Thank you again.

Signed:

(Research Participant)

Student:Instructor: Dr. David IaquintaTelephone #402.465.2426Students [email protected]

PARENTAL INFORMED CONSENT FORMIntergenerational Views on the Family

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

Your child is eligible to participate in this study because your child of your relationship and because you have already agreed to participate in the study yourself.

The purpose of this study is to investigate the perceptions and experiences of parents and children regarding their family life.

This study will take a maximum of thirty to sixty minutes of your childs time. Your child will be asked various questions about their experiences in the family and their perceptions of the familys role in society.

There are no known risks associated with this research.

Any information obtained during this research which could identify your child will be kept strictly confidential.

Your childs rights as a research subject have been explained to you. If you have any additional questions concerning your childs rights, you may contact Dr. David Iaquinta at Nebraska Wesleyan University at (402)465-2426.

You are free to decide not to enroll your child in this study or to withdraw your child at any time without adversely affecting their or your relationship with the investigator or Nebraska Wesleyan University. Your decision will not result in any loss of benefits to which your child is otherwise entitled.

DOCUMENTATION OF INFORMED CONSENT

YOU ARE VOLUNTARILY MAKING A DECISION WHETHER OR NOT TO ALLOW YOUR CHILD TO PARTICIPATE IN THIS RESEARCH STUDY. YOUR SIGNATURE CERTIFIES THAT YOU HAVE DECIDED TO ALLOW YOUR CHILD TO PARTICIPATE HAVING READ AND UNDERSTOOD THE INFORMATION PRESENTED. YOU WILL BE GIVEN A COPY OF THIS CONSENT FORM TO KEEP.

____________________________________________ ______________________

SIGNATURE OF PARENT

DATE

PRIMARY INVESTIGATOR: Students name and

info hereCOURSE INSTRUCTOR:Dr. David Iaquinta; 402.465.2426

[email protected]

Appendix E

YOUTH ASSENT FORM

Intergenerational Views on the FamilyWe are inviting you to participate in this study because your parent has agreed to also be part of a study of attitudes and perceptions relevant to your family.This research will take a maximum of thirty to sixty minutes of your time. You will be asked several questions concerning your experiences and opinions about family life and its relationship to the larger society.Your responses will be strictly confidential. There will be no records kept of your interview that would make it possible for anyone to identify you.

I am also asking your parent(s) for their permission for you to do this study. Please talk this over with them before you decide whether or not to participate.

If you have any questions at any time, please ask the researcher.

If you check yes it means that you have decided to participate and have read everything that is on this form. You and your parents will be given a copy of this form to keep.

_______ Yes, I would like to participate in the study.

_______ No, I do not want to participate in this study.

_________________________________________

________________________

SIGNATURE OF SUBJECT

DATE

_________________________________________

________________________

SIGNATURE OF INVESTIGATOR

DATE

If you have any questions about the study, you may contact me or my Supervising Professor at the numbers below.

PRIMARY INVESTIGATOR: Students name and

info hereCOURSE INSTRUCTOR: Dr. David Iaquinta; 402.465.2426 [email protected]